Provider Contracts Manager HP - Complex

Molina Healthcare • Syracuse, NY • 3d 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: $66,456 - $155,508 / ANNUAL

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

Similar Jobs

Industrial Electrician at Superior Metals Manufacturing (Chittenango, NY)

Consolidated Precision Products • Chittenango, NY • 23h ago

Legal & Paralegal

Join Our Growing Team as an Industrial Electrician at Superior Metals Manufacturing! Job Summary: Are you looking for your next challenge? Join us as an Industrial Electrician and become an intricate part of our success....

23h ago

Go to Apply

Mechanical Engineer 5(Industrial/Process)

CDM Smith • Syracuse, NY • 1d ago

Legal & Paralegal

43061BR Requisition ID: 43061BR Business Unit: IND Job Description: With general direction, creates engineering designs including: Reviews draft designs for compliance with federal, state and local regulations and signs...

1d ago

Go to Apply

Industrial Maintenance Mechanic II - 1st shift

Anoplate Corporation • Syracuse, NY • 5d ago

Legal & Paralegal

Industrial Maintenance Mechanic II - 1st shift Syracuse, NY ( http://maps.google.com/maps?q=459+Pulaski+St+Syracuse+NY+USA+13204 ) Job Type Full-time Description 1st Shift: 6:00am - 2:30pm Monday - Friday Anoplate is see...

5d ago

Go to Apply

Sr. Account Manager, Industrial Water Treatment

Veralto • Syracuse, NY • 5d ago

Legal & Paralegal

??This water treatment sales position is focused on managing existing accounts and growing new business to drive ChemTreat's market position within a geography or an industry. ? ?They will be responsible for retaining an...

5d ago

Go to Apply

Attorney

Carr Recruiting Solutions - CNY Outsourcing Inc • Syracuse, NY • 1w ago

Legal & Paralegal

Attorney - Syracuse, NY area Candidates must have civil litigation experience and be prepared to handle cases from inception through trial, including drafting discovery pleadings and motions & taking and defending de...

1w ago

Go to Apply

Industrial Wastewater Process Engineer

Ramboll US Corporation • Syracuse, NY • 2w ago

Legal & Paralegal

Company DescriptionJob Description - Industrial Wastewater Process EngineerInviting Bright MindsRamboll is seeking motivated and inquisitive candidates to join the Water Division in our Syracuse, NY, Rochester, NY, Brent...

2w ago

Go to Apply

Legal Secretary

Robert Half • Syracuse, NY • 2w ago

Legal & Paralegal

Description We are looking for an experienced Legal Secretary to join our team in Syracuse, New York. This contract-to-permanent position offers an excellent opportunity to contribute to a dynamic legal environment while...

2w ago

Go to Apply

Industrial Painter

Aerotek • Liverpool, NY • 2w ago

Legal & Paralegal

Job Title: Industrial Painter Job Description As an Industrial Painter, you will bring your expertise in surface preparation, epoxy mixing, and equipment maintenance to ensure high-quality finishes on structural steel, m...

2w ago

Go to Apply

Industrial Engineering Internship Summer 2026

TTM TECHNOLOGIES, INC. • Syracuse, NY • 2w ago

Legal & Paralegal

TTM Technologies, Inc. - Publicly Traded US Company, NASDAQ (TTMI) - Top-5 Global Printed Circuit Board ManufacturerAbout TTM TTM Technologies, Inc. is a leading global manufacturer of technology solutions including engi...

2w ago

Go to Apply

Industrial Maintenance Technician MRF 2nd shift

WM • Liverpool, NY • 3w ago

Legal & Paralegal

I. Job Summary The Plant Maintenance Technician is responsible for monitoring and maintaining the operation of all plant systems and equipment. Including but not limited to balers, conveyor belts, gearboxes, electrical m...

3w 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.