AVP, National Value-Based Contracting

Provides strategy and leadership to the team responsible for value-based contracting (VBC) activities. Responsible for valuating, negotiating, implementing, and expanding the organization’s VBC portfolio across the enterprise.

Responsibilities

• Supports strategy development, vision, and direction for value-based contracting (VBC) across the Molina enterprise.
• Demonstrates accountability for performance and financial results; keeps executive leadership apprised.
• Leads ideation, development, and implementation of value-based contracts (VBC) in all Molina markets.
• Develops strategies for growing member attribution to value-based agreements at national and state levels.
• Identifies and negotiates value-based contracts (VBC) that lower the total cost of healthcare for the organization.
• Contributes as a key member of the national network leadership team to facilitate development of network strategic goals for VBC.
• Recommends guidelines for value-based contracting and provides leadership on strategic development in new markets.
• Leverages expert-level knowledge of reimbursement methodologies for value-based contracts across all lines of business.
• Manages complex external VBC partnerships to drive value-based strategy.
• Assesses internal and external risks associated with VBC, including state regulations, RFPs, data infrastructures, and internal processes.
• Defines, proposes, and aligns stakeholders around a unified VBC operating model to mitigate risks.
• Creates standards for VBC analytics, data, and reconciliation processes with providers (PADU framework).
• Ensures alignment with key stakeholders: network, medical economics, EIM, actuarial, finance, risk adjustment, and quality.
• Implements and executes the enterprise-wide VBC operating model.
• Provides monthly reporting to stakeholders, including executive leadership.
• Maintains strong partnerships with medical economics, network, actuarial, finance, EIM, and IT teams.
• Manages multiple, complex VBC and cross-enterprise projects.
• Hires, trains, manages, and evaluates team performance; provides coaching, development, and recognition.
• Develops and sustains a high-performance team dedicated to best-in-class solutions.
• Some travel to markets may be required (up to 15%).

Requirements

• At least 10 years of experience in network contracting, and at least 8 years in value-based care (VBC) contracting, or equivalent combination of education and experience.
• At least 5 years of management/leadership experience.
• Extensive experience in the health insurance industry.
• Expert-level knowledge of reimbursement methodologies for value-based contracts across all lines of business (Medicaid, Medicare, Marketplace).
• Strong experience with managed healthcare provider compensation methodologies.
• Excellent negotiation and relationship-building capabilities.
• Ability to navigate complex 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.
• Strong project management skills.
• Excellent verbal and written communication skills, including executive-level presentations.
• Proficiency in Microsoft Office suite and applicable software programs.

Preferred Qualifications

• Project Management Professional (PMP) or Six Sigma green belt certification.

Pay

Pay Range: $140,795 - $274,550.26 per year. Actual compensation may vary based on geographic location, work experience, education, and skill level.