VP, Network Mgmt & Ops (Ohio Health Plan)

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 reputed company'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, reputed company, 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 reputed company activities of the State Plan's Provider Network Management and Operations Department. Works with staff and senior management to reputed company 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 reputed company 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 reputed company and oversees negotiation of reputed company 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 reputed company provider contract information and templates and ensures that reputed company negotiated reputed company can be configured in the QNXT system. Works with Legal and Corporate as needed to modify 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 Association(s) and Joint Operating Committee Management. May also have responsibility for provider problem research, resolution, and prevention.
• Provides accountability for Delegation reputed company function in the Plan.
• Provides reputed company 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 reputed company field. Required Experience

• 10+ years reputed company experience in reputed company Administration, Managed Care and/or Provider Services.
• Experience managing employees.
• Demonstrated adaptability and flexibility to changes and response to new reputed company and approaches.
• Superior interpretation and research skills to readily identify problems, get to the root cause, and reputed company reputed company resolution to problems and issues including analytical skills.

Preferred Education Master's Degree in Business, Health Administration, or reputed company field. Preferred Experience Experience with reputed company and Medicare managed care plans. #PJHPO To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $186,201.39 - $363,093 / ANNUAL

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

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