Director, Provider Contracts (Texas Health Plan) - REMOTE

Molina Healthcare

315d • $97,299 - $189,732 • Remote

About The Position

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, staffs, and coordinates the Provider Contracts activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.

Requirements

• Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.
• 7+ years' experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position.
• 5+ years' experience in provider contract negotiations in a managed healthcare setting including in negotiating different provider contract types and VBP models.
• Working experience with, and strong knowledge of, various managed healthcare provider compensation and VBP methodologies, primarily across Medicaid and Medicare lines of business.
• Min. 2 years' experience managing/supervising employees.

Nice To Haves

• Master's Degree in a related field or an equivalent combination of education and experience.
• 10+ years Provider contract negotiation experience.

Responsibilities

• Manages the Plan's Provider Contracting functions and team members.
• Responsible for leading the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Contracting functions.
• Leads negotiations of contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers.
• Contract/Re-contracting with large scale entities involving custom reimbursement.
• Executes standardized Alternative Payment Method or Value Based Payment (VBP) contracts.
• Leads initiatives and activities issue escalations, network adequacy, and Joint Operating Committees.
• Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.
• Oversees development of provider contracting strategies including VBP.
• Leads the achievement of annual savings through re-contracting initiatives.
• Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
• Leads preparation and negotiations of provider contracts and oversee negotiation of contracts, including VBP.
• Utilizes standardized contract templates and VBP/Pay for Performance strategies.
• Develops and maintains Reimbursement Tolerance Parameters (across multiple specialties/ geographies).
• Oversees the development of new reimbursement models.
• Communicates new strategies to corporate provider network leadership for input.
• Utilizes standardized system(s) to track contract negotiation activity on an ongoing basis throughout the year.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.
• Oversees the maintenance of all Provider Contract templates including VBP program templates.
• Works with Legal and Corporate Network Management as needed to modify contract templates.
• Manages the contracting relationships with area agencies and community partners to support and advance Plan initiatives.
• Develops and implements contracting strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.
• Manages and provides coaching to Network Contracting Staff.
• Manages and evaluates team member performance; provides coaching, consultation, employee development, and recognition.
• Ensures ongoing, appropriate staff training; holds regular team meetings to drive good communication and collaboration.
• Has responsibility for the selection, orientation and mentoring of new staff.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree