Provider Contracts Manager

Molina Healthcare • Tacoma, WA • 5h 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

Industrial Water Engineer

Parametrix • South Hill, WA • 3d ago

Legal & Paralegal

Industrial Water Engineer About Parametrix Parametrix is a 100% employee-owned consulting firm helping clients deliver resilient infrastructure, vibrant and livable communities, and environmentally sustainable solutions....

3d ago

Go to Apply

Industrial Project Manager - Electric Utilities

CDM Smith • Tacoma, 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

Robert Half • Seatac, WA • 1w ago

Legal & Paralegal

Description Robert Half is partnering with a public sector in the Greater Seattle Area to identify a Litigation Paralegal who is ready to IMMEDIATELY jump in to assist and possibly join their team. Location: Greater Seat...

1w ago

Go to Apply

Lead Corporate Counsel

PeopleReady • Tacoma, WA • 2w ago

Legal & Paralegal

Overview: TrueBlue, Inc. (NYSE:TBI) is the people company. We were founded on the idea that by connecting people and work, we can help our clients grow their businesses while growing ours. Since our first office opened m...

2w ago

Go to Apply

Bankruptcy Paralegal

Robert Half • Federal Way, WA • 3w ago

Legal & Paralegal

Description A boutique law firm in South Seattle is seeking a Paralegal to join their team, handling consumer bankruptcy cases. Salary range is 65-100k DOE. Benefits include medical and dental insurance (gold PPO plan wi...

3w ago

Go to Apply

Associate General Counsel

Robert Half • Seatac, WA • 3w ago

Legal & Paralegal

Description We are looking for a highly skilled Attorney to join our legal team in the Seattle/Tacoma area. This role demands a proactive and strategic approach to legal matters, providing expert guidance to support the...

3w ago

Go to Apply

Supply Chain Program Manager, Contract Services

Alaska Airlines • Seatac, WA • 4w ago

Legal & Paralegal

Company Alaska Airlines The Team Guided by our purpose, core values, and leadership principles, we are creating an airline people love. Our corporate teams set the strategies and operational plans to ensure the success o...

4w ago

Go to Apply

Entry-level Lube Tech/Technician

Valvoline • Sumner, WA • 4h ago

Retail & Hospitality

ALL ROADS LEAD TO THIS OPPORTUNITY The journey to Valvoline Instant Oil Change (VIOC) is different for everyone. Our employees are students, recent grads, parents, veterans, career changers-who have all found their way t...

4h ago

Go to Apply

Administrative Assistant

Aston Carter • Federal Way, WA • 5h ago

Management & Administrative

Job Title: Administrative AssistantJob Description The Administrative Assistant will provide vital support to three managers, assisting with projects and offering back-up support to other administrative assistants. This...

5h ago

Go to Apply

Administrative Assistant

Aston Carter • Federal Way, WA • 5h ago

Management & Administrative

5h 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.