Provider Contracts Manager

Molina Healthcare • Ohio, Ohio • 59min ago

JOB DESCRIPTION

Job Summary

Negotiates National agreements with highly visible providers including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.

KNOWLEDGE/SKILLS/ABILITIES

In conjunction with Director/Manager Provider Contracts, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.

Develops and maintains provider contracts in APTTUS 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.

Maintains contractual relationships with significant/highly visible providers.

Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.

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 and legal.

Educates internal customers on provider contracts.

Participates on the management team and other committees addressing the strategic goals of the department and organization.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience.

Required Experience

5-7 years

Preferred Education

Graduate degree

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.

ASSISTANT GENERAL COUNSEL, ENERGY, INSTALLATIONS & ENVIRONMENT (EI&E)

Department of the Navy/Assistant for Administration • Virginia, Virginia • 1w ago

Legal & Paralegal

Summary The Department of the Navy (DON) Office of the General Counsel (OGC) seeks an exceptional leader to serve as the Assistant General Counsel (Energy, Installations & Environment). The AGC (EIE) is a special sta...

1w ago

Go to Apply

Attorney III - Public Defender

Nevada County • California, California • 2w ago

Legal & Paralegal

Attorney III - Public Defender Print ( https://www.governmentjobs.com/careers/mynevadacounty/jobs/newprint/5145149 ) Apply ? Attorney III - Public Defender Salary $139,024.92 - $169,720.80 Annually Location CA 95959, CA...

2w ago

Go to Apply

Attorney II - Public Defender

Nevada County • California, California • 2w ago

Legal & Paralegal

Attorney II - Public Defender Print ( https://www.governmentjobs.com/careers/mynevadacounty/jobs/newprint/5145136 ) Apply ? Attorney II - Public Defender Salary $123,340.92 - $150,573.84 Annually Location CA 95959, CA Jo...

2w ago

Go to Apply

Law Enforcement Strategic Advisor

SAIC • Virginia, Virginia • 2w ago

Legal & Paralegal

Description The successful candidate for this position will support the identification of on-contract growth opportunities as well as the maturation and shaping of new opportunities with specific emphasis on SAIC's solut...

2w ago

Go to Apply

Deputy District Attorney III

Mendocino County Sheriff's Office • California, California • 2w ago

Legal & Paralegal

Deputy District Attorney III Print ( https://www.governmentjobs.com/careers/mendocinoca/jobs/newprint/5143495 ) Apply ? Deputy District Attorney III Salary $112,424.00 - $136,676.80 Annually Location Various locations th...

2w 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.