VP, Network Strategy & Services - Mississippi Health Plan

JOB DESCRIPTION 

Job Summary

Provides executive strategy and leadership to team responsible for provider network management, provider relations, and contracting activities.  Leads network strategy and development with respect to adequacy, financial performance, and operational performance.  Develops network standards and resources designed to enable Molina to establish and maintain distinct high-performing networks of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values.

This role supports a strong, experienced team and requires someone who can move quickly, make sound decisions, and negotiate complex, high‑visibility contracts with hospitals and providers. Candidate must reside in Mississippi.

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.
• Develops and implements provider network and contract strategies in new Molina markets - 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 strategies consistent with reimbursement tolerance parameters (across multiple specialties/geographies).  
• Oversees the development of new reimbursement models; facilitates communication, oversight and approval processes for health plan exceptions for all lines of business.
Develops and enhances the provider network management and operations function including the implementation of standard processes, policies and procedures. 
• Develops a standardized provider engagement “tool kit”, training program and deployment plan.; develops and implements approaches to determining outcomes of tools and training programs. 
• Collaborates closely with health plans leadership to ensure compliance with all Molina, regulatory and industry standards.  
• Supports and executes new health plan implementations,  acquisitions and expansions in collaboration with the business development team. 
• Collaborates with senior leadership, health plan leadership, and collaborating functions to develop and implement provider contracting strategies and provider service strategies to contain unit cost, improve member access and enhance provider satisfaction enterprise-wide. 
• Develops and oversees deployment strategy and monitoring for “provider profiles” and “pay-for-performance (P4P)” contracting.
• In conjunction with provider services and provider contracting leaders in the health plans and within the corporate function, develops and implements approaches for performance management of value-based reimbursement.
• Develops and refines “clear coverage” provider adoption strategies and assists in training of health plan staff as clear coverage is implemented in each plan.
• Represents provider engagement with stakeholder experience, quality and RAMP business partners to ensure incorporate of necessary plans to achieve positive operational and financial outcomes.
• Develops and maintains a system to track contract negotiation activities; facilitates health plan implementation, utilization, compliance, and develops and delivers enterprise-wide training for the contract management system.
• Develops and authors all enterprise contract templates in conjunction with legal; disseminates templates, and maintains and updates to include state regulatory changes, operational business objectives and financial terms; maintains language libraries for the enterprise.
• Directs the strategy, preparation and negotiations of national provider contracts across the enterprise; oversees negotiation of national contracts in concert with established company templates and guidelines with vendors, physicians, hospitals, and other health care providers.
• Monitors key metrics to determine provider engagement effectiveness and success (e.g. provider appeals and grievances, member appeals and grievances, Consumer Assessment of Healthcare Providers and Systems (CAHPs), STAR ratings, Healthcare Effectiveness Data Information Set (HEDIS), HEP completion Rates, etc.)
• Leads and manages the development and implementation of activities for network development and contracting projects.
• Directs the evaluation, review, and negotiation processes for network development projects.
• Supports business development and new business implementation engagements across markets, taking into consideration individual market circumstances, provider community, budget guidelines and available resources.
• Completes neg