VP, Network Management (Work Location - Illinois)
for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We must only include sections that have real specific content. The posting includes Job Summary, Essential Job Duties, Required Qualifications, Preferred Qualifications, Work Location, Pay Range. Also maybe Benefits? Not mentioned except "competitive benefits and compensation package" but not specifics. So we should not create Benefits section unless specifics given. Pay section: we have Pay Range. So include Pay. Schedule: not given. So omit.
We need to use for section headings. Use - for any list of duties/requirements/benefits. Use
for prose.
We must not repeat job title as heading. Do not put Job ID/requisition numbers as headings. We have none.
We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, application instructions. The posting includes "To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board." That's application instruction; remove. Also "Molina Healthcare offers a competitive benefits and compensation package." That's vague but maybe we can keep as prose? It's not specific benefit details; but it's substantive? It's a statement about benefits. The instruction says: remove boilerplate, duplicated lines, and application instructions. That line is not exactly boilerplate but it's a generic statement about benefits; could be considered fluff. However we need to preserve ALL substantive information; does "competitive benefits and compensation package" count as substantive? It's vague but it's still information. The instruction says: Prefer a few substantive sections over many thin ones. We could include a Benefits section with that statement? But they said never create Benefits section unless posting actually states them. It does state "competitive benefits and compensation package." That's a statement about benefits, albeit vague. I'd include a Benefits section with that statement as a
. However they also said never emit a heading followed by filler/placeholder text (e.g., "commensurate with experience", "not specified", "N/A", "varies", "TBD"). "competitive benefits and compensation package" is not filler; it's a statement. So we can include Benefits.
Pay: we have Pay Range: $186,201.39 - $363,093 / ANNUAL Actual compensation may vary... We'll include Pay section with that as
.
Schedule: not given, omit.
Now structure:
We have Job Summary (maybe "About the role" heading). Use
About the role
then with the job summary text.
Then Responsibilities:
Responsibilities
then - each duty.
Then Requirements: maybe combine Required Qualifications and Preferred Qualifications? Could have
Required Qualifications
and Preferred Qualifications
. Or combine into Qualifications. The instruction says use headings like Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can choose Qualifications for required and preferred. But we need to preserve all info; we can have two subsections? Not allowed to create extra headings beyond those listed? It says use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but suggests those as examples. Safer to stick to those. We could have Requirements
for required qualifications, and Preferred Qualifications
maybe not in list but could be okay. However they said "Use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." The e.g. indicates those are examples, not exhaustive. So we can add Preferred Qualifications as a heading.
But we need to avoid thin sections. Preferred Qualifications has just one line: "Deep experience with Medicaid, Medicare, and Marketplace managed care plans. #PJHPO". The #PJHPO looks like a tag; we should keep it? It's likely internal code; we should preserve? It's substantive? Probably not needed but it's part of posting. We'll keep as part of the line.
We also have Work Location - Downers Grove, IL - Employees must reside within the state of Illinois. This is not a heading; we can put in a
under maybe About the role or separate? Could be its own section like "Location" but not in list. We could incorporate into About the role paragraph.
We must not include duplicated lines. Ensure we capture all duties.
Let's extract duties from "Essential Job Duties -" bullet list (they are separated by periods). We'll split into items.
List:
- 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 - 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 strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); oversees the development of new reimbursement models, and obtains input from corporate and legal on new reimbursement models.
- Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the contract management system.
- Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers.
- Contributes as a key member of the senior leadership team and other committees; responsible to address the strategic goals of the department and organization.
- Oversees the maintenance of all provider contract information, provider contract templates and ensure that all contracts negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
- Oversees plan-specific fee schedule management.
- Develops strategies to improve EDI/MASS rates.
- Provides oversight of provider services and coordinates activities with provider associations and joint operating committee (JOC) leadership.
- Provides accountability for the delegation oversight function in the plan.
- Provides oversight of the provider network administration area including: provider information management and business analyses of contracts and benefits to support accurate configuration for claims payment.
- Oversees all provider/member problem prevention, research and resolution, and provides oversight of the provider/member appeals and grievance process.
- Coordinates with enrollment growth to ensure that Molina grows faster (profitable growth) than competitors in key provider practices.
- Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration.
- Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.
We need to ensure each is a
- .
Now Required Qualifications: list bullet style? It's a paragraph with multiple sentences separated by periods. We'll split into items maybe each sentence as
- . But we could also keep as
. The instruction: use
- for any list of duties/requirements/benefits. So if we have multiple items, we should list. The Required Qualifications section contains multiple qualifications; we can treat each as list item.
Let's parse:
- At least 12 years experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 10 years of senior level network operations experience, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Extensive experience in the health insurance industry.
- Track record of strong relationships with hospitals, provider groups, and independent physician associations (IPAs).
- Expert level knowledge regarding reimbursement methodologies across all lines of business (Medicaid, Medicare, Marketplace).
- Strong experience with various managed health care provider compensation methodologies.
- Excellent negotiation and relationship building capabilities.
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
- Superior interpretation and research skills in order to readily identify problems, get to the root-cause and achieve prompt issue/problem resolution.
- 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, and influence business decisions.
- Ability to manage multiple tasks and deadlines effectively.
- Strong project management skills.
- Excellent verbal and written communication skills, and ability to present at an executive level.
- Microsoft Office suite and applicable software programs proficiency.
That's many items.
Preferred Qualifications: "Deep experience with Medicaid, Medicare, and Marketplace managed care plans. #PJHPO". Could be one item.
Now Pay: we have Pay Range: $186,201.39 - $363,093 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
We'll put that in a
under Pay heading.
Benefits: "Molina Healthcare offers a competitive benefits and compensation package." We'll put that in a
under Benefits heading.
Location: maybe include in About the role paragraph.
Now produce HTML.
We must not include or . Just fragment.
Let's craft.
About the role
Provides executive strategy and leadership to team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Also responsible for negotiating complex contracts that are strategically critical to plan/product success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements. Establishes and maintains a distinct high-performing and adequate network of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values. Work Location - Downers Grove, IL - Employees must reside within the state of Illinois.
Responsibilities
- 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 - 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 strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); oversees the development of new reimbursement models, and obtains input from corporate and legal on new reimbursement models.
- Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the contract management system.
- Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers.
- Contributes as a key member of the senior leadership team and other committees; responsible to address the strategic goals of the department and organization.
- Oversees the maintenance of all provider contract information, provider contract templates and ensure that all contracts negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or
- for any list of duties/requirements/benefits. Use
for prose. We must not repeat job title as heading. Do not put Job ID/requisition numbers as headings. We have none. We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, application instructions. The posting includes "To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board." That's application instruction; remove. Also "Molina Healthcare offers a competitive benefits and compensation package." That's vague but maybe we can keep as prose? It's not specific benefit details; but it's substantive? It's a statement about benefits. The instruction says: remove boilerplate, duplicated lines, and application instructions. That line is not exactly boilerplate but it's a generic statement about benefits; could be considered fluff. However we need to preserve ALL substantive information; does "competitive benefits and compensation package" count as substantive? It's vague but it's still information. The instruction says: Prefer a few substantive sections over many thin ones. We could include a Benefits section with that statement? But they said never create Benefits section unless posting actually states them. It does state "competitive benefits and compensation package." That's a statement about benefits, albeit vague. I'd include a Benefits section with that statement as a
. However they also said never emit a heading followed by filler/placeholder text (e.g., "commensurate with experience", "not specified", "N/A", "varies", "TBD"). "competitive benefits and compensation package" is not filler; it's a statement. So we can include Benefits. Pay: we have Pay Range: $186,201.39 - $363,093 / ANNUAL Actual compensation may vary... We'll include Pay section with that as
. Schedule: not given, omit. Now structure: We have Job Summary (maybe "About the role" heading). Use
About the role
thenwith the job summary text. Then Responsibilities:
Responsibilities
then- each duty.
Then Requirements: maybe combine Required Qualifications and Preferred Qualifications? Could have
Required Qualifications
andPreferred Qualifications
. Or combine into Qualifications. The instruction says use headings like Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can choose Qualifications for required and preferred. But we need to preserve all info; we can have two subsections? Not allowed to create extra headings beyond those listed? It says usefor section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but suggests those as examples. Safer to stick to those. We could have
Requirements
for required qualifications, andPreferred Qualifications
maybe not in list but could be okay. However they said "Usefor section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." The e.g. indicates those are examples, not exhaustive. So we can add Preferred Qualifications as a heading. But we need to avoid thin sections. Preferred Qualifications has just one line: "Deep experience with Medicaid, Medicare, and Marketplace managed care plans. #PJHPO". The #PJHPO looks like a tag; we should keep it? It's likely internal code; we should preserve? It's substantive? Probably not needed but it's part of posting. We'll keep as part of the line. We also have Work Location - Downers Grove, IL - Employees must reside within the state of Illinois. This is not a heading; we can put in a
under maybe About the role or separate? Could be its own section like "Location" but not in list. We could incorporate into About the role paragraph. We must not include duplicated lines. Ensure we capture all duties. Let's extract duties from "Essential Job Duties -" bullet list (they are separated by periods). We'll split into items. List: - 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 - 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 strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); oversees the development of new reimbursement models, and obtains input from corporate and legal on new reimbursement models. - Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the contract management system. - Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers. - Contributes as a key member of the senior leadership team and other committees; responsible to address the strategic goals of the department and organization. - Oversees the maintenance of all provider contract information, provider contract templates and ensure that all contracts negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. - Oversees plan-specific fee schedule management. - Develops strategies to improve EDI/MASS rates. - Provides oversight of provider services and coordinates activities with provider associations and joint operating committee (JOC) leadership. - Provides accountability for the delegation oversight function in the plan. - Provides oversight of the provider network administration area including: provider information management and business analyses of contracts and benefits to support accurate configuration for claims payment. - Oversees all provider/member problem prevention, research and resolution, and provides oversight of the provider/member appeals and grievance process. - Coordinates with enrollment growth to ensure that Molina grows faster (profitable growth) than competitors in key provider practices. - Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. - Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives. We need to ensure each is a
- . Now Required Qualifications: list bullet style? It's a paragraph with multiple sentences separated by periods. We'll split into items maybe each sentence as
- . But we could also keep as
. The instruction: use
- for any list of duties/requirements/benefits. So if we have multiple items, we should list. The Required Qualifications section contains multiple qualifications; we can treat each as list item.
Let's parse:
- At least 12 years experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 10 years of senior level network operations experience, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Extensive experience in the health insurance industry.
- Track record of strong relationships with hospitals, provider groups, and independent physician associations (IPAs).
- Expert level knowledge regarding reimbursement methodologies across all lines of business (Medicaid, Medicare, Marketplace).
- Strong experience with various managed health care provider compensation methodologies.
- Excellent negotiation and relationship building capabilities.
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
- Superior interpretation and research skills in order to readily identify problems, get to the root-cause and achieve prompt issue/problem resolution.
- 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, and influence business decisions.
- Ability to manage multiple tasks and deadlines effectively.
- Strong project management skills.
- Excellent verbal and written communication skills, and ability to present at an executive level.
- Microsoft Office suite and applicable software programs proficiency.
That's many items.
Preferred Qualifications: "Deep experience with Medicaid, Medicare, and Marketplace managed care plans. #PJHPO". Could be one item.
Now Pay: we have Pay Range: $186,201.39 - $363,093 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
We'll put that in a
under Pay heading. Benefits: "Molina Healthcare offers a competitive benefits and compensation package." We'll put that in a
under Benefits heading. Location: maybe include in About the role paragraph. Now produce HTML. We must not include or . Just fragment. Let's craft.
About the role
Provides executive strategy and leadership to team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Also responsible for negotiating complex contracts that are strategically critical to plan/product success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements. Establishes and maintains a distinct high-performing and adequate network of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values. Work Location - Downers Grove, IL - Employees must reside within the state of Illinois.
Responsibilities
- 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 - 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 strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); oversees the development of new reimbursement models, and obtains input from corporate and legal on new reimbursement models.
- Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the contract management system.
- Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers.
- Contributes as a key member of the senior leadership team and other committees; responsible to address the strategic goals of the department and organization.
- Oversees the maintenance of all provider contract information, provider contract templates and ensure that all contracts negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or
- for any list of duties/requirements/benefits. So if we have multiple items, we should list. The Required Qualifications section contains multiple qualifications; we can treat each as list item.
Let's parse:
- At least 12 years experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 10 years of senior level network operations experience, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Extensive experience in the health insurance industry.
- Track record of strong relationships with hospitals, provider groups, and independent physician associations (IPAs).
- Expert level knowledge regarding reimbursement methodologies across all lines of business (Medicaid, Medicare, Marketplace).
- Strong experience with various managed health care provider compensation methodologies.
- Excellent negotiation and relationship building capabilities.
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
- Superior interpretation and research skills in order to readily identify problems, get to the root-cause and achieve prompt issue/problem resolution.
- 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, and influence business decisions.
- Ability to manage multiple tasks and deadlines effectively.
- Strong project management skills.
- Excellent verbal and written communication skills, and ability to present at an executive level.
- Microsoft Office suite and applicable software programs proficiency.
That's many items.
Preferred Qualifications: "Deep experience with Medicaid, Medicare, and Marketplace managed care plans. #PJHPO". Could be one item.
Now Pay: we have Pay Range: $186,201.39 - $363,093 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
We'll put that in a
- each duty.
Then Requirements: maybe combine Required Qualifications and Preferred Qualifications? Could have