Manager, Health Plan Provider Contracts

Molina Healthcare•Long Beach, CA

About The Position

Leads and manages the team responsible for health plan provider network contracting. Supports network strategy and development related to adequacy, financial performance, and operational performance. Negotiates complex contracts that are strategically critical to plan success, including alternative payment models (APMs), value-based payment (VBP) contracts, and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements. The role oversees provider contracting activities, develops health plan-specific contracting strategies, supports network adequacy and cost-control initiatives, and ensures contracts and network practices comply with corporate and regulatory requirements. It also manages team performance through hiring, training, coaching, development, and regular communication.

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 a managed health care setting, ideally involving 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 lines of business, including VBP, fee-for-service (FFS), 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.

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 business stakeholders on contracting activities.
Negotiate contracts with complex providers to establish high-quality, cost-effective, and marketable provider networks.
Contract and re-contract with large-scale entities involving custom reimbursement.
Execute standardized alternative payment model (APM) and value-based payment (VBP) contracts.
Issue escalations and support network adequacy, joint operating committees (JOCs), and delegation oversight.
Develop health plan-specific provider contracting strategies with contracting leadership, including VBP strategies and selection of specialties, geographic areas, and provider targets.
Support annual savings through recontracting initiatives and implement cost-control initiatives to influence the medical cost ratio (MCR) in contracted regions.
Prepare provider contracts with physicians, hospitals, managed long-term services and supports (MLTSS), and other health care providers in accordance with company guidelines.
Use established reimbursement tolerance parameters and oversee development of new reimbursement models.
Oversee maintenance of provider and payer contract templates and collaborate with legal and corporate network management to ensure compliance with contractual and regulatory requirements.
Ensure compliance with provider panel and network capacity and adequacy requirements; produce and monitor reports tracking compliance.
Develop, implement, monitor, and adjust strategies to minimize the company’s financial exposure and achieve desired goals.
Advise network provider contract specialists on negotiations for individual provider and routine ancillary contracts.
Evaluate the provider network and implement strategic plans to meet Molina’s 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 needed.
Educate internal customers on provider contracts.
Participate on the management team and other committees addressing departmental and organizational strategic goals.
Hire, train, manage, and evaluate team members; provide coaching, development, and recognition; ensure appropriate ongoing staff training; hold regular team meetings; and promote communication and collaboration.