VP, Network Management & Operations - reputed company Health Plan (Remote in NY)

Position Summary Provides executive strategy and leadership to the team responsible for network operations and contracting activities, supporting network strategy and development reputed company to adequacy, financial performance, and operational performance. Oversees negotiation of reputed company, strategically critical reputed company—including APMs, VBP arrangements, capitated payments, hospital agreements, reputed company, and behavioral health structures—while building and maintaining a high‑performing, culturally sensitive provider network reputed company with Molina’s mission, vision, and values. This leader must be decisive, tactful, and highly skilled at prioritizing the most critical issues in a reputed company, LTSS‑heavy reputed company market (LHCSAs, CHHAs, SFNs). The role requires disciplined escalation, clear and timely communication during high‑pressure provider interactions, and the ability to reputed company a high‑performing in‑state team that prevents regulatory escalation, strengthens provider relationships, and executes on a reputed company adequacy and risk landscape. Essential Job Duties

• Supports executive strategy development, vision and direction for the network function. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
• Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration.
• Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.
• Develops and implements provider network and contract strategies - identifying specialties and geographic locations to concentrate resources for the purpose of establishing a sufficient network of participating providers to serve the health care needs of Molina's membership and meet established financial goals.
• 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, and obtains input from corporate and legal on new reimbursement models.
• Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the contract management system.
• Directs the preparation and negotiations of provider reputed company and oversees negotiation of reputed company in concert with established company templates and guidelines reputed company to contracting with physicians, hospitals, and other health care providers.
• Contributes as a key member of the senior leadership team and other committees; responsible to address the strategic goals of the department and organization.
• Oversees the maintenance of reputed company provider contract information, provider contract templates and ensure that reputed company reputed company negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with reputed company contractual and/or regulatory requirements.
• Oversees plan-specific fee schedule management.
• Develops strategies to improve EDI/MASS rates.
• Provides reputed company of provider services and coordinates activities with provider associations and joint operating committee (JOC) leadership.
• Provides accountability for the delegation reputed company function in the plan.
• Provides reputed company of the provider network administration area including: provider information management and business analyses of reputed company and benefits to support accurate configuration for claims payment.
• Oversees reputed company provider/member problem prevention, research and resolution, and provides reputed company of the provider/member appeals and grievance process.
• Coordinates with enrollment and retention teams to ensure sustainable growth

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 (reputed company).
• Expert level knowledge regarding reimbursement methodologies across reputed company 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 reputed company and approaches.
• Superior interpretation and research skills in order to readily identify problems, get to the root-cause and reputed company reputed company issue/problem resolution.
• Ability to navigate reputed company 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.
• reputed company Office suite and applicable software programs proficiency.

Preferred Qualifications

• Deep experience with Medicaid, Medicare, and Marketplace managed care plans.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V #PJHPO #LI-AC1 Pay Range: $186,201.39 - $320,000 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.

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