Principal Strategist, Network Contracting

Job Description

Job Description

Job Summary

The Principal Strategist, Network Contracting is responsible for overseeing the Marketplace provider contracting strategies and execution for their assigned regions. Leads the Marketplace's provider strategy, while developing and maintaining strong and consistent relationships with assigned health plan markets. Manages key provider relationships - both through health plan partners (Plan Presidents, local Network and Contracting leaders, etc.) as well as directly with key providers - and demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. Co-create and/or oversee the development and management of Molina's internal Marketplace rate approval process that meets internal unit cost standards. Assist in the annual development and oversight of Molina's Marketplace fee schedule while leading enterprise-wide understanding of Marketplace fee schedules, contracting best practices, and industry standards.

Job Duties

• Formulate network strategies for assigned markets, including new-market entry ideation, unit cost optimization, value-based care strategies, and other competitive network delivery solutions that enable growth and unit cost enterprise initiatives, collaborating with product strategy, operations, sales, clinical, health plan, and other relevant internal stakeholders
• Develop provider negotiation strategy documents outlining key upcoming negotiations. Includes provider profiles, market and network context, historical and projected financial impacts, quality and performance metrics, and strategic alignment with growth and enterprise goals. Additionally, strategy documents should include proposed contracting terms, internal recommendations, negotiation guardrails, and key levers to drive successful outcomes
• Collaborate with medical economics and actuarial partners to develop detailed provider reimbursement strategies that support enterprise initiatives
• Showcase industry experience and expertise in Marketplace standard fee schedules and contracting strategies, including a strong understanding of CMS reimbursement methodologies and commercial fee-for-service models
• Evaluate top provider performance in assigned markets to guide contracting decisions and shape network strategies effectively
• Routinely meet with assigned markets to engage on network goals and ongoing progress. Review anticipated provider contracts for execution
• Review ongoing provider reimbursement rate approvals from assigned markets, synthesize impact and provide recommendation for leadership approval or adjustments
• Collaborate with configuration, finance, compliance, contracting, and other teams to ensure contract language and rates meet internal policies and requirements. Provide support in developing and refining template contract language for both facility and professional agreements, ensuring alignment with organizational standards, regulatory requirements, and strategic contracting goals. Collaborate with internal stakeholders to recommend appropriate language that enhances contract clarity and operational clarity
• Partner with internal stakeholders to support network adequacy, resolve provider issues, and improve access to care
• Support annual projects related to network expansion, cost management and operational efficiency, reporting on progress in assigned markets and escalating risks where appropriate
• Leverage 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
• Understand Marketplace value-based care (VBC) models available to leverage in assigned markets
• Contribute to ideation and development of process improvements to essential business activities, including rate approval process, network expansion, and strategy development
• Maintain a professional and courteous demeanor in all interactions with providers and internal stakeholders while driving structure, organization, and shared goals

Job Qualifications

REQUIRED QUALIFICATIONS:

• Bachelor's Degree or equivalent combination of education and work experience
• 7-9 years of healthcare provider contracting and strategy experience, and a strong understanding of healthcare industry regulations
• Experience with contract management software and negotiation techniques

PREFERRED QUALIFICATIONS:

• Graduate Degree or equivalent combination of education and experience
• Certified Professional in Healthcare Quality (CPHQ)

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