Remote and must live in Ohio
Job Description
Job Summary
Molina Health Plan Provider Network Contracting jobs are responsible for the value-based payments (VBP) network strategy and development with respect to 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.
Responsible for contracting/re-contracting of Complex contracts with Alternative Payment Methods including but not limited to Value Based and Capitated payments for Hospitals, Independent Practice Associations, and complex Behavioral Health arrangements.
Manages VBP's through negotiation, implementation, and management.
Entail value-based contracting negotiations and understanding of alternative arrangements.
Maintains critical Complex provider information on claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database.
Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
Manages the exchange of data and reporting for all state-led VBP's.
Job Duties
Manages the Plan's Provider Contracting functions and team members. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Contracting functions. 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 or Value Based Payment (VBP) contracts. The role manages VBP's from initiation and contracting through ongoing management activities including educations and performance reviews. Issue escalations, Joint Operating Committees, and delegation oversight.
In conjunction with Director, Provider Contracts, develops health plan-specific VBP provider contracting strategies. This includes identifying VBP provider targets and assist with the development of VBC models to meet Molina goals.
Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, MLTSS and other health care providers.
Utilizes established Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with Director.
Oversees the maintenance of all Provider and payer Contract Templates. Works with legal and Corporate Network Management on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
Ensures compliance with applicable APM requirements and guidelines. Produces and monitors reports on a recurring basis to track and monitor compliance with APM requirements.
Manages the exchange of data and reporting for all state-led VBP's to ensure timely and accurate exchange.
Develops and implements strategies to minimize the company's financial exposure. Monitors and adjusts strategy implementation as needed to achieve desire goals and reduce minimize the company's financial exposure.
Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
Participates in development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management, legal and VP level engagement as required.
Educates internal customers on provider contracts.
Participates on the management team and other committees addressing the strategic goals of the department and organization.
Manages and provides coaching to Network Contracts Staff.
Manages and evaluates team member performance; provides coaching, consultation, employee development, and recognition; ensures ongoing, appropriate staff training; holds regular team meetings to drive good communication and collaboration; and has responsibility for the selection, orientation and mentoring of new staff.
Job Qualifications
REQUIRED EDUCATION :
Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :
5-7 years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position
3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract @types, i.e. physician, group and hospital contracting, etc.
Working experience with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc.
Min. 2 years experience managing/supervising employees.
PREFERRED EDUCATION :
Master's Degree in a related field or an equivalent combination of education and experience
PREFERRED EXPERIENCE :
Experience Negotiating Alternative Payment Methods
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.
Pay Range: $73,102 - $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
