Provider Contracts Manager

Molina Healthcare • Spokane, WA • 2d ago

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.

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

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 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, legal and VP level engagement as required.

Educates internal customers on provider contracts.

Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary 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

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 :

5-7 years contract-related experience in the health care field including, but not limited to, provider's office, managed care organization, or other health care environment.

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 familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee-for service, capitation and various forms of risk, ASO, etc.

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.

Pay Range: $77,969 - $155,508 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

Attorney 3-Criminal Department

Spokane County • Spokane, WA • 1w ago

Legal & Paralegal

Attorney 3-Criminal Department Print ( https://www.governmentjobs.com/careers/spokanecountywa/jobs/newprint/5003301 ) Apply ? Attorney 3-Criminal Department Salary $104,833.96 - $146,720.27 Annually Location WA 99260, WA...

1w ago

Go to Apply

Industrial Project Manager - Electric Utilities

CDM Smith • Spokane, WA • 1w ago

Legal & Paralegal

41990BR Requisition ID: 41990BR Business Unit: IND Job Description: CDM Smith Industrial Division is seeking to fill an exciting Project Manager position in our established and growing business with electric utility clie...

1w ago

Go to Apply

Paralegal-Civil Department

Spokane County • Spokane, WA • 2w ago

Legal & Paralegal

Paralegal-Civil Department Print ( https://www.governmentjobs.com/careers/spokanecountywa/jobs/newprint/4979508 ) Apply ? Paralegal-Civil Department Salary $51,743.31 - $72,473.70 Annually Location WA 99260, WA Job Type...

2w ago

Go to Apply

Data Analytics Consulting Staff (Finance & Accounting)

Moss Adams LLP • Spokane, WA • 8h ago

Finance & Accounting

Data Analytics Consulting Staff (Finance & Accounting) Description At Moss Adams, we champion authenticity. For us, that means fostering a culture of talented people who care-about you, about our clients, and about o...

8h ago

Go to Apply

Director, Operational Oversight (REMOTE)

Molina Healthcare • Spokane, WA • 8h ago

Job Description Job Summary Responsible for planning, developing and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews...

8h ago

Go to Apply

Senior Accountant

Robert Half • Spokane, WA • 14h ago

Finance & Accounting

Description Robert Half Company is looking for an experienced and detail-oriented Senior Accountant for our local clients ongoing needs in the area. This role is ideal for an experienced accountant with a strong backgrou...

14h ago

Go to Apply

Accounting Clerk

Robert Half • Spokane, WA • 14h ago

Finance & Accounting

Description Robert Half Company is looking for a Contract Accounting Clerk for our local clients ongoing needs in the area. This position is ideal for someone with strong attention to detail and organizational skills who...

14h ago

Go to Apply

Outside Sales Rep

United Rentals • Spokane Valley, WA • 1d ago

Sales & Marketing

Great company. Great people. Great opportunities. If you'd like the chance to make your mark with the world's largest equipment rental provider, come build your future with United Rentals! As an Outside Sales Rep -- Tren...

1d ago

Go to Apply

National Accounts Manager

Zimmer Biomet • Spokane, WA • 1d ago

Management & Administrative

At Zimmer Biomet, we believe in pushing the boundaries of innovation and driving our mission forward. As a global medical technology leader for nearly 100 years, a patient's mobility is enhanced by a Zimmer Biomet produc...

1d ago

Go to Apply

Medical Technician - Phlebotomy

Veterans Affairs, Veterans Health Administration • Spokane, WA • 1d ago

Hospital & Medical

Summary These positions are located in the Pathology & Laboratory Medicine Service (P&LMS) at the Mann-Grandstaff VAMC in Spokane, WA. Responsibilities THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE W...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.