Provider Contracts Manager (Value-Based)

Molina Talent Acquisition

68d

About The Position

Negotiates value-based agreements with highly visible providers including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.

Requirements

• Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience.
• 5-7 years of experience.

Nice To Haves

• Graduate degree.

Responsibilities

• In conjunction with Director/Manager Provider Contracts, negotiates value-based high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
• Develops and maintains provider contracts in APTTUS contract management software.
• Targets and recruits additional providers to reduce member access grievances.
• Engages targeted contracted providers in renegotiation of rates and/or language.
• Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.
• Maintains contractual relationships with significant/highly visible providers.
• Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.
• Evaluates provider network and implement strategic plans with the goal of meeting Molina's network adequacy standards.
• Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
• Participates in fee schedule determinations including development of new reimbursement models.
• Seeks input on new reimbursement models from Corporate Network Management and legal.
• Educates internal customers on provider contracts.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.

What This Job Offers

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