VP, Network Management (Illinois)
On-siteDowners Grove, Illinois, United States
Job Summary
Lead executive strategy and leadership for network operations and contracting, negotiating complex contracts for hospitals, physician associations, and behavioral health arrangements. Develop and implement provider network strategies to establish a sufficient network aligned with Molina's mission, while overseeing plan-specific fee schedule management and EDI/MASS rate improvements. Direct contract negotiations, maintain provider contract information in the QNXT system, and provide oversight of provider services, appeals, and grievance processes. Manage team performance, coordinate with provider associations, and drive profitable growth strategies in key provider practices. Contribute as a key member of the senior leadership team to address strategic organizational goals.
Required Qualifications
- At least 12 years experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 10 years of senior level network operations experience, or equivalent combination of relevant education and experience
- At least 7 years management/leadership experience
- Extensive experience in the health insurance industry
- Track record of strong relationships with hospitals, provider groups, and independent physician associations (IPAs)
- Expert level knowledge regarding reimbursement methodologies across all lines of business (Medicaid, Medicare, Marketplace)
- Strong experience with various managed health care provider compensation methodologies
- Excellent negotiation and relationship building capabilities
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches
- Superior interpretation and research skills in order to readily identify problems, get to the root-cause and achieve prompt issue/problem resolution
- Ability to navigate complex regulatory environments
- Data-driven decision-making skills, and strong analytical abilities
- Strong organizational skills and attention to detail
- Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization, and influence business decisions
- Ability to manage multiple tasks and deadlines effectively
- Strong project management skills
- Excellent verbal and written communication skills, and ability to present at an executive level
- Microsoft Office suite and applicable software programs proficiency
Desired Qualifications
- Deep experience with Medicaid, Medicare, and Marketplace managed care plans
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