Provider Contracts Manager

Molina Healthcare

85d • $59,811 - $129,589 • Remote

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. This role 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. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight are also part of the responsibilities. The position requires ongoing engagement with contracted providers after the contract is established.

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, primarily 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 including Hospitals, Independent Physician Associations, and complex Behavioral Health arrangements.
• Execute standardized Alternative Payment Method contracts.
• Manage issue escalations, network adequacy, Joint Operating Committees, and delegation oversight.
• Negotiate Complex Provider contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
• Develop and maintain provider contracts in contract management software.
• Target and recruit additional providers to reduce member access grievances.
• Engage contracted providers in renegotiation of rates and/or language.
• Assist with cost control strategies that positively impact the Medical Care Ratio (MCR).
• 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 and 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 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.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree