Provider Contracts Manager HP - Complex (Remote in ID)

Molina Talent Acquisition

115d

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

• Negotiates 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 contracts.
• Handles issue escalations, network adequacy, Joint Operating Committees, and delegation oversight.
• Negotiates Complex Provider contracts including high priority physician group and facility contracts using PADU guidelines.
• Develops and maintains provider contracts in contract management software.
• Targets and recruits additional providers to reduce member access grievances.
• Engages targeted contracted providers in renegotiation of rates and/or language.
• Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
• Maintains contractual relationships with significant/highly visible providers.
• Evaluates provider network and implements strategic plans to meet Molina’s network adequacy standards.
• Assesses contract language for compliance with Corporate standards and regulatory requirements.
• Participates in fee schedule determinations including development of new reimbursement models.
• Educates internal customers on provider contracts.
• Communicates contract terms, payment structures, and reimbursement rates to providers.
• Participates with the management team and other committees addressing the strategic goals of the department and organization.
• Participates in other contracting related special projects as directed.
• Travels regularly throughout designated regions to meet targeted needs.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

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