Provider Contracts Manager

Molina Healthcare • Davenport, IA • 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

Marketing Assistant NF-03

Army Installation Management Command • Rock Island, IL • 21h ago

Sales & Marketing

Summary This position is located at Rock Island, Illinois. To better expedite the hiring process, we recommend including full contact information (name, address, phone number, email, etc.) for professional and personal r...

21h ago

Go to Apply

Warehouse Technician

Aerotek • Davenport, IA • 21h ago

IT & Engineering

Warehouse Technician 3PM - midnight $18.75 Job Description Join our expanding team as a Warehouse Technician in our newly expanded facility equipped with the latest cutting and tempering machines. We are looking for dedi...

21h ago

Go to Apply

Pharmacy Customer Service Associate

Walgreens • Davenport, IA • 22h ago

Hospital & Medical

Job Description: Models and delivers a distinctive and delightful customer experience. Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service. In acco...

22h ago

Go to Apply

CDL A Delivery Truck Driver

Performance Food Group • Rock Island, IL • 22h ago

Trucking & Construction

125223BR Job Title: CDL A Delivery Truck Driver Location: Performance TPC Logistics (0754) Job Description: Position Details: $30.45 per hour for drivers with 1+ years experience! Paid Weekly! 4 or 5 day work week! We De...

22h ago

Go to Apply

Warehouse Worker (1st Shift)

Aerotek • Davenport, IA • 22h ago

Manufacturing & Warehouse

Now Hiring: Warehouse Picker - 1st Shift | Davenport, IA| $16-17/HR Looking to grow your warehouse career with a company that values quality over speed? We're hiring a Warehouse Picker for our 1st shift team! Schedule: M...

22h ago

Go to Apply

Truck Driver

Roehl Transport • Eldridge, IA • 22h ago

Trucking & Construction

In our over the road Flatbed Fleet, you'll haul unique freight mostly east of I-35 (though you may have loads that'll take you through any of the lower 48 states and Canada). As you see the nation, you'll also see many d...

22h ago

Go to Apply

Accountant

Palmer College of Chiropractic • Davenport, IA • 1d ago

Finance & Accounting

Palmer College of Chiropractic is looking for an Accountant! The Accountant will be responsible for recording accounting activity, reconciling general ledger accounts, managing payment processing services, maintaining fi...

1d ago

Go to Apply

Account Sales Manager

Keurig Dr Pepper • Davenport, IA • 1d ago

Management & Administrative

Job Overview: Account Sales Manager for Greater Quad Cities Area Hiring Immediately The Account Sales Manager is responsible for up-selling and fulfillment/replenishment, focused on execution and merchandising. Accountab...

1d ago

Go to Apply

Physical Therapist - Per Diem

Select Medical • Davenport, IA • 1d ago

Hospital & Medical

Overview Position: Physical Therapist (PT) Location: Davenport, IA Schedule: Per Diem / As Needed / Flexible Schedule Compensation: $53.00 Per Hour Select Specialty Hospital is a critical illness recovery hospital commit...

1d ago

Go to Apply

Market Grille Clerk

Hy-Vee Food Stores • Bettendorf, IA • 1d ago

Management & Administrative

Additional Considerations (if any): Night & Weekend Shifts Required - At Hy-Vee our people are our strength. We promise "a helpful smile in every aisle" and those smiles can only come from a workforce that is fully e...

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.