Provider Contracts Manager - Complex (Remote in ID)

Job Description

Job Summary

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.

Job Duties

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. Tighter knit proximity ongoing after contract.

• In conjunction with Director / Manager, Provider Contracts, negotiates Complex Provider contracts including but not limited to high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.

Emphasis on number or percentage of Membership in Value Based Relationship Contracts.

Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.

Job Qualifications

REQUIRED EDUCATION :

Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.

REQUIRED EXPERIENCE / KNOWLEDGE, SKILLS & ABILITIES :

contract-related experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care environment.

PREFERRED EDUCATION :

Master's Degree in a related field or an equivalent combination of education and experience

PREFERRED EXPERIENCE :

3+ years in Provider Network contracting

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

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Pay Range : $66,456 - $129,590 / ANNUAL