VP, Network Mgmt & Ops
Company: Molina Healthcare
Location: Kingston
Posted on: May 15, 2022
Job Description:
JOB DESCRIPTION Job Summary Molina Health Plan Operational
Leadership roles provide overall direction and administration of
the Plan's operational departments, programs, and services.
Responsibilities include implementing programs that are in
alignment with Molina Healthcare's strategic and operating plan;
providing day-to-day leadership and management of the health plan
market or product operations that mirrors the company's mission,
vision, and core values; and ensuring the efficient and compliant
operations of the market or product of the health plan.
KNOWLEDGE/SKILLS/ABILITIES Plans, organizes, staffs, and leads all
activities of the State Plan's Provider Network Management and
Operations Department. Works with staff and senior management to
develop and implement provider contracting and service strategies
to contain unit cost, improve member access and enhance provider
satisfaction with the Plan. Also oversees provider credentialing,
delegation oversight and provider network administration
activities. Primary plan liaison for Claims, Member Services and
other Corporate Departments.
- Develops and implements provider network and contract
strategies, identifying those specialties and geographic locations
on which to concentrate resources for purposes of establishing a
sufficient network of Participating Providers to serve the health
care needs of the Plan's membership.
- Develops and maintains a market-specific provider reimbursement
strategy consistent with Reimbursement Tolerance Parameters (across
multiple specialties/geographies). Oversees the development of new
reimbursement models. Obtains input from Corporate and Legal
regarding new reimbursement models.
- Develops and maintains a system to track contract negotiation
activity on an ongoing basis throughout the year; utilize and
oversees departmental training on Molina's contract management
system.
- Directs the preparation and negotiations of provider contracts
and oversees negotiation of contracts in concert with established
company templates and guidelines with physicians, hospitals, and
other health care providers.
- Contributes as a key member of the Senior Leadership Team and
other committees addressing the strategic goals of the department
and organization.
- Oversees the maintenance of all provider contract information
and templates and ensures that all negotiated contracts can be
configured in the QNXT system. Works with Legal and Corporate as
needed to modify templates to ensure compliance with all
contractual and/or regulatory requirements.
- Oversees plan-specific fee schedule management.
- Develops strategies to improve EDI/MASS rates.
- Provides oversight of Provider Services and coordinates
activities with Provider Association(s) and Joint Operating
Committee Management. May also have responsibility for provider
problem research, resolution, and prevention.
- Provides accountability for Delegation Oversight function in
the Plan.
- Provides oversight of the Provider Network Administration area
to ensure accuracy of provider information in support of accurate
configuration for claims payment. JOB QUALIFICATIONS Required
Education Bachelor's Degree in Business, Health Services
Administration, or related field. Required Experience
- 10+ years progressive experience in Healthcare Administration,
Managed Care and/or Provider Services.
- Experience managing employees.
- Demonstrated adaptability and flexibility to changes and
response to new ideas and approaches.
- Superior interpretation and research skills to readily identify
problems, get to the root cause, and achieve prompt resolution to
problems and issues including analytical skills. Preferred
Education Master's Degree in Business, Health Administration, or
related field. Preferred Experience Experience with Medicaid and
Medicare managed care plans. To all current Molina employees: If
you are interested in applying for this position, please apply
through the intranet job listing. Molina Healthcare offers a
competitive benefits and compensation package. Molina Healthcare is
an Equal Opportunity Employer (EOE) M/F/D/V. #PJHPO
#LiI-BeMore
Keywords: Molina Healthcare, Seattle , VP, Network Mgmt & Ops, Executive , Kingston, Washington
Didn't find what you're looking for? Search again!
Loading more jobs...