About this role
Job Description
Job Summary
Provides subject matter expertise for identifying, developing, and operationalizing scalable cost of care and network performance initiatives across the enterprise. Leads the end-to-end lifecycle from unvetted ideas through discovery and development, including defining payer-provider opportunities and quantifying plausible cost savings.
Job Duties
• Generate, curate, and prioritize early-stage ideas for cost and network improvement initiatives, balancing innovation with regulatory, compliance and operational constraints. • Lead structured discovery efforts – including data analysis, stakeholder input, and external benchmarking – to mature unvetted ideas into defined concepts, provider behavior change hypotheses, and credible cost-savings business cases with scorable action items (SAIs). • Partner with analytics, finance, clinical, and other cross-functional teams to ensure business cases and initiatives are credible, defensible, and aligned with enterprise standards. • Identify and monitor industry trends in health care cost, provider reimbursement, and utilization management, with a focus on implications for Medicare, Medicaid, Duals and Marketplace lines of business. • Serve as a bridge between corporate strategy and health plan execution, converting approved initiatives into clear, standardized playbooks that are adaptable to local market variation while preserving enterprise targets. • Present concepts, business cases, and playbooks to senior leadership and executive stakeholders, influencing prioritization, investment decisions, and rollout strategy. • Create and execute enterprise operational plans to deploy initiatives, leading market teams and health plans through execution, monitoring performance against forecasts, and iterating to amplify impact. • Provide end-to-end oversight of internal business projects and programs from initiation through delivery, ensuring adherence to scope, schedule, budget and structured design, analysis, and delivery practices; engage and oversee external vendors as needed. • Proactively identify implementation barriers, compliance considerations, and change management risks; establish and manage a disciplined issue escalation and resolution process to remove roadblocks and maintain momentum. • Support change management, communication planning, and stakeholder readiness to ensure successful adoption and sustained outcomes of delivered solutions.
Job Qualifications
REQUIRED QUALIFICATIONS:
• At least 7 years of experience in a Managed Care environment, or equivalent combination of relevant education and experience. • Provider network contracting and management experience. • Critical-thinking, problem-solving and analytical skills. • Ability to process corporate strategy and strategic priorities into a roadmap within assigned network performance areas. • Excellent communication skills across all levels of leadership. • Ability to collaborate across teams in a highly matrixed organization. • Ability to build relationships, translate data into action and drive/influence change and initiatives across the enterprise..
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.