Manager, Health Plan Provider Contracts (Michigan)

Molina Healthcare•Detroit, MI

5h•$80,412 - $156,803

About The Position

The Manager, Health Plan Provider Contracts leads and manages a team responsible for health plan provider network contracting activities. The role supports network strategy and development related to network adequacy, financial performance, and operational performance. It negotiates strategically critical, complex contracts, including alternative payment models (APMs), value-based payment (VBP) contracts, and capitated arrangements with hospitals, independent physician associations, and complex behavioral health providers. The employee must reside in Michigan. The position oversees provider contracting, develops health plan-specific contracting strategies, supports network adequacy and cost-control initiatives, oversees contract templates and compliance, and advises contracting specialists. It also manages and develops the team, including hiring, training, coaching, and evaluating performance.

Requirements

At least 7 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 4 years of provider contract negotiation experience in managed health care, ideally across physician, group, and hospital contract types; or an equivalent combination of relevant education and experience.
At least 1 year of management or leadership experience.
Experience with managed health care provider compensation methodologies, primarily across Medicaid and Medicare, including VBP, fee-for-service, capitation, and various forms of risk.
Strong negotiation and relationship-building capabilities.
Ability to navigate complex regulatory environments.
Strong organizational skills and attention to detail.
Data-driven decision-making skills and analytical abilities.
Ability to work cross-functionally with internal and external stakeholders in a highly matrixed organization.
Ability to manage multiple tasks and deadlines effectively.
Strong verbal and written communication skills.
Proficiency with Microsoft Office suite and applicable software programs.
Must reside in Michigan.

Nice To Haves

Experience negotiating alternative payment models (APMs).
Experience with Medicaid, Medicare, and Marketplace government-sponsored programs.

Responsibilities

Oversee the plan’s provider contracting function and collaborate with operational departments and functional business stakeholders on contracting activities.
Negotiate contracts with complex provider organizations to establish high-quality, cost-effective, marketable provider networks.
Contract and re-contract with large-scale entities involving custom reimbursement, and execute and oversee non-standard contracts.
Issue escalations and support network adequacy, joint operating committees, and delegation oversight.
Develop health plan-specific provider contracting strategies with contracting leadership, including VBP strategies and identification of priority specialties, geographic locations, and provider targets.
Support annual savings through re-contracting initiatives and implement cost-control initiatives intended to influence the medical cost ratio in contracted regions.
Prepare provider contracts with physicians, hospitals, managed long-term services and supports providers, and other health care providers, following company guidelines.
Apply reimbursement tolerance parameters and oversee development of new reimbursement models.
Oversee provider and payer contract templates and collaborate with legal and corporate network management to modify templates as needed for contractual and regulatory compliance.
Ensure compliance with provider panel and network capacity and adequacy requirements; produce and monitor weekly and monthly compliance reports.
Develop and implement strategies to minimize the company’s financial exposure, monitoring and adjusting implementation as needed.
Advise network provider contract specialists on negotiations for individual providers and routine ancillary contracts.
Evaluate the provider network and implement strategic plans to meet 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 and development of reimbursement models, seeking input from corporate network management, legal, and senior-level stakeholders as required.
Educate internal customers about provider contracts.
Participate on the management team and on committees addressing department and organizational strategic goals.
Hire, train, manage, and evaluate team members; provide coaching, development, and recognition; ensure appropriate ongoing staff training; and promote communication and collaboration through regular team meetings.