Health Plan Provider Contracts Mgr - Complex (Behavioral Health)

Molina Healthcare•Long Beach, NY

About The Position

Provides subject matter expertise and leadership for complex health plan provider-network contracting activities, supporting network strategy and development related to adequacy, financial performance, and operational performance. The role negotiates agreements with hospitals, independent physician associations (IPAs), behavioral health organizations, OMH and OASAS providers, ancillary facilities, and out-of-network providers. The manager executes, manages, and optimizes provider contracts; supports network adequacy and cost-control strategies; analyzes deal terms and reimbursement models; and maintains relationships with significant providers. The role also advises and trains contracting team members, educates internal customers on provider contracts, and collaborates with internal and external stakeholders on strategic goals and special projects. Approximately 3–10% travel within New York State is required, and the role requires the ability to work independently with minimal supervision.

Requirements

At least 5 years of experience in network contracting with large specialty or multispecialty provider groups.
At least 3 years of experience in provider contract negotiations in a managed health care setting, ideally negotiating different provider contract types such as physician, group, and hospital contracts, or an equivalent combination of relevant education and experience.
Working familiarity with managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including value-based payment, fee-for-service, capitation, and various forms of risk.
Negotiation and relationship-building capabilities.
Ability to navigate complex regulatory environments.
Data-driven decision-making skills and analytical abilities.
Organizational skills and attention to detail.
Ability to work cross-functionally with internal and external stakeholders in a highly matrixed organization.
Ability to manage multiple tasks and deadlines effectively.
Effective verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs.

Nice To Haves

Contracting experience with integrated delivery systems, hospitals, and specialty or ancillary groups.
Experience with Medicaid, Medicare, and Marketplace government-sponsored programs.
Behavioral health experience.
Experience with DocuSign, Salesforce, Microsoft Office, and contract management software.

Responsibilities

Negotiate contracts with behavioral health providers in the complex provider community to secure high-quality, cost-effective, marketable plan providers.
Contract and re-contract with large-scale entities involving custom reimbursement; execute standardized alternative payment model contracts; issue escalations; and support network adequacy, joint operating committees, and delegation oversight.
Execute, manage, and optimize provider contracts.
Direct analysis of the financial impact of deal terms and prepare details and justification for executive approval of agreements outside Molina approval guidelines.
Negotiate complex provider contracts with contracting leadership, including high-priority physician group and facility contracts using preferred, acceptable, discouraged, and unacceptable guidelines, with emphasis on membership in value-based relationship contracts.
Develop and maintain provider contracts in contract management software.
Target and recruit additional providers to reduce member access grievances.
Engage targeted contracted providers in renegotiation of rates or contract language and assist with cost-control strategies that positively affect the medical cost ratio within each region.
Advise network contracting team members on negotiating individual provider and routine ancillary contracts.
Maintain contractual relationships with significant and highly visible providers.
Evaluate the provider network and implement strategic plans to meet Molina network adequacy standards.
Assess contract language for compliance with corporate standards and regulatory requirements, and review revised language with the assigned corporate attorney.
Participate in fee-schedule determinations, including development of new reimbursement models, seeking input from corporate network leadership, legal, and senior-level stakeholders as needed.
Educate internal customers on provider contracts.
Communicate contract terms, payment structures, and reimbursement rates clearly and professionally to physician, hospital, and ancillary providers.
Participate with leadership and other committees to address department and organizational strategic goals.
Participate in contracting-related special projects as directed.
Provide training, mentoring, and support to new and existing contracting team members.
Travel approximately 3–10% within New York State.
Work independently with minimal supervision to complete daily objectives.