Provider Contracts Manager (Health Systems)

Molina Talent Acquisition

84d

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. Negotiates agreements with Complex providers who are strategic to the success of the Plan, including but not limited to, Hospitals, Independent Physician Association, and complex Behavioral Health arrangements.

Requirements

• Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.
• 5-7 years contract-related experience in the health care field including provider’s office, managed care organization, or other health care environment.
• 3+ years experience in provider contract negotiations in a managed healthcare setting.
• Working familiarity with various managed healthcare provider compensation methodologies across Medicaid and Medicare lines of business.

Nice To Haves

• Master's Degree in a related field or an equivalent combination of education and experience.
• 3+ years in Provider Network contracting.

Responsibilities

• Negotiate 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.
• Execute standardized Alternative Payment Method contracts.
• Handle issue escalations, network adequacy, Joint Operating Committees, and delegation oversight.
• Negotiate Complex Provider contracts including high priority physician group and facility contracts using PADU guidelines.
• 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 and/or language.
• Assist with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.
• Advise Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
• Maintain contractual relationships with significant/highly visible providers.
• Evaluate provider network and implement strategic plans to meet Molina’s network adequacy standards.
• Assess contract language for compliance with Corporate standards and regulatory requirements.
• Participate in fee schedule determinations including development of new reimbursement models.
• Educate internal customers on provider contracts.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Participate with the management team and other committees addressing the strategic goals of the department and organization.
• Participate in other contracting related special projects as directed.
• Travel regularly throughout designated regions to meet targeted needs.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees