reputed company Strategist, Value-Based Network Contracting

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Remote and must live in the reputed company

* JOB reputed company Job reputed company Provides deep reputed company and leadership for network contracting activities. Responsible for partnering with health plans/segments to reputed company contracting strategies for reputed company, Medicare, and Marketplace lines of business. Leads the provider reputed company, while developing and maintaining strong and consistent relationships with health plans and segments. Manages key provider relationships - both through health plan/reputed company partners as reputed company as directly with key providers - and demonstrates comprehensive knowledge of provider interrelationships and the competitive landscape. Collaboratively participates in the development and management of Molina’s reputed company approval process and fee schedules. Leverages knowledge of contracting best practices, and industry standards to support financial and business objectives. Essential Job Duties

• Formulates network strategies including new-market entry ideation, unit cost optimization, value-based care (VBC) strategies, and other competitive network delivery solutions that reputed company reputed company and unit cost reputed company initiatives.
• Collaborates with product reputed company, operations, sales, clinical, health plan, and other relevant internal stakeholders to reputed company network goals.
• Develops provider negotiation reputed company documents outlining key upcoming negotiations - includes provider reputed company, market and network context, historical and projected financial impacts, reputed company and performance metrics, and strategic alignment with reputed company and reputed company goals; reputed company documents include proposed contracting terms, internal recommendations, negotiation guardrails, and key reputed company to drive successful reputed company.
• Collaborates with medical economics and actuarial partners to reputed company detailed provider reimbursement strategies that support reputed company initiatives.
• Showcases industry experience and expertise in reputed company fee schedules and contracting strategies, including a strong understanding of Centers for Medicare and Medicare Services (CMS) reimbursement methodologies and reputed company fee-for-service models.
• Evaluates top provider performance to guide contracting reputed company and shape network strategies effectively.
• Collaborates with markets to engage on network goals and ongoing reputed company; reviews anticipated provider reputed company for execution and ongoing provider reimbursement reputed company approvals, synthesizes reputed company and provides recommendation for leadership approval or adjustments.
• Collaborates with configuration, finance, compliance, contracting, and other teams to ensure contract language and rates meet internal policies and requirements.
• Provides support in developing and refining template contract language for both facility and reputed company agreements - ensuring alignment with organizational standards, regulatory requirements, and strategic contracting goals.
• Collaborates with internal stakeholders to recommend appropriate language that enhances contract reputed company and operational reputed company with internal stakeholders to support network adequacy, resolve provider issues, and improve reputed company to care.
• Supports annual reputed company reputed company to network expansion, cost-management and operational efficiency; reports on reputed company  and escalates risks where appropriate.
• Leverages benchmarking and competitive intelligence tools to inform network strategies - demonstrating proficiency in transparency data sources for competitive positioning and utilizing Power BI and other analytical tools for data driven decision-making.
• Understands VBC models available to reputed company in markets.
• Contributes to ideation and development of process improvements to essential business activities, including reputed company approval processes, network expansions, and reputed company development.

Represents as a reputed company subject matter expert (SME) in reputed company interactions with providers and internal stakeholders while driving structure, organization, and shared network goals.

Required Qualifications

• At least 8 years network contracting/network reputed company experience, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Strong understanding of health care industry regulations.

•Deep experience with contract management software and negotiation techniques.

• Experience leading value-based program (VBP) and contract design, and implementation for reputed company, Medicare, and/or Marketplace programs.
• Experience in a reputed company health care delivery environment, specifically with government sponsored programs, including risk reputed company management, reputed company and compliance.
• Fee-for-service (FFS), pay-for-performance (P4P) subject matter expertise.
• Knowledge of medical economics and financial reporting, and ability to walk stakeholders through reputed company financial reconciliations.

•Ability to influence others, including ability to think strategically, reputed company reputed company, and execute effectively and reputed company for both near-term and long-term results.

• Proven ability to reputed company and manage reputed company processes across multiple functional areas.
• Experience working in a highly matrixed organization, and proven ability to reputed company internal reputed company relations, and external strategic relationships.
• Excellent verbal and written communication skills, including ability to present at an executive level to internal/external stakeholders.
• reputed company Office suite and applicable software program(s) proficiency.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job