Provider Contracts Manager

Molina Healthcare • Akron, OH • 11h 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 Project Manager - Electric Utilities

CDM Smith • Akron, OH • 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

Industrial Maintenance Technician

McCann Plastics LLC • North Canton, OH • 1w ago

Legal & Paralegal

Are You Looking For A Fantastic Long Term Career Opportunity With A Stable Company? McCann Plastics is currently accepting applications for 1st and 3rd shift Industrial Machine Maintenance Technicians. Competitive Pay th...

1w ago

Go to Apply

Advanced Compliance Specialist - Asset & Records Control - Akron Fairlawn

FirstEnergy Corp • Akron, OH • 2w ago

Legal & Paralegal

JOB DESCRIPTION FirstEnergy at a Glance We are a forward-thinking electric utility powered by a diverse team of employees committed to making customers' lives brighter, the environment better and our communities stronger...

2w ago

Go to Apply

Advanced Compliance Specialist - Asset & Records Control - Akron Fairlawn

FirstEnergy Corp • Akron, OH • 2w ago

Legal & Paralegal

2w ago

Go to Apply

Corporate Counsel - Legal & Corp Secretary - Akron FirstEnergy Headquarters

FirstEnergy Corp • Akron, OH • 2w ago

Legal & Paralegal

JOB DESCRIPTION FirstEnergy Corp. FirstEnergy Service Company is a subsidiary of FirstEnergy Corp. FirstEnergy Corp. is a public utility holding company headquartered in Akron, Ohio. FirstEnergy Corp.'s public utility su...

2w ago

Go to Apply

Attorney - Legal & Corp Secretary - Akron General Office Bldg

FirstEnergy Corp • Akron, OH • 2w ago

Legal & Paralegal

JOB DESCRIPTION FirstEnergy Service Company FirstEnergy Service Company is a subsidiary of FirstEnergy Corp. FirstEnergy Corp. is a public utility holding company headquartered in Akron, Ohio. FirstEnergy Corp.'s public...

2w ago

Go to Apply

Attorney - Legal & Corp Secretary - Akron General Office Bldg

FirstEnergy • Akron, OH • 2w ago

Legal & Paralegal

FirstEnergy Service Company FirstEnergy Service Company is a subsidiary of FirstEnergy Corp. FirstEnergy Corp. is a public utility holding company headquartered in Akron, Ohio. FirstEnergy Corp.'s public utility subsidia...

2w ago

Go to Apply

Attorney (Open to entry level)

Robert Half • Tallmadge, OH • 3w ago

Legal & Paralegal

Description Immediate Opportunity for Recent Law Graduates! We're seeking a motivated and detail-oriented Attorney to join an established in-house legal team in Tallmadge, OH. This is an excellent opportunity for recent...

3w ago

Go to Apply

Paralegal Specialist - Akron Office

FirstEnergy Corp • Akron, OH • 3w ago

Legal & Paralegal

JOB DESCRIPTION FirstEnergy at a Glance FirstEnergy (NYSE: FE) is a diversified energy company dedicated to safety, reliability and operational excellence. Headquartered in Akron, Ohio, FirstEnergy comprises one of the n...

3w ago

Go to Apply

Data Engineer - Industrials & Energy Sector - Senior Manager - Consulting - Location Open

EY • Akron, OH • 4w ago

Legal & Paralegal

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY...

4w 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.