Health Plan Provider Contracts Manager - Complex

Molina Healthcare • Bellevue, NE • 1d ago

JOB DESCRIPTION

Job Summary

Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Responsible for negotiating agreements, including value-based payment methodology, with complex provider groups that are strategically critical to plan success, including but not limited to: hospitals, independent physician associations (IPAs), and behavioral health organizations.

Essential Job Duties

Negotiates contracts and letters of agreement with the complex provider community to secure high quality, cost-effective and marketable plan providers.

Contracts/re-contracts with large-scale entities involving custom reimbursement; executes standardized alternative payment model (APM) contracts; issues escalations, and supports network adequacy, joint operating committees (JOCs), and delegation oversight.

Execution, management, and optimization of value-based contracts and enhanced provider relationship management.

Directs analysis of financial impact of deal terms and prepare details and justification for executive approval for agreements outside of Molina approval guidelines.

In conjunction with contracting leadership, negotiates complex provider contracts including 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 cost ratio (MCR) within each region.

Advises network contracting team members 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 corporate attorney.

Participates in fee schedule determinations including development of new reimbursement models; seeks input on new reimbursement models from corporate network leadership, legal and senior 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 leadership team and other committees to address the strategic goals of the department and organization.

Participates in contracting-related special projects as directed.

Provides training, mentoring and support to new and existing contracting team members.

Ad hoc travel throughout NE, primarily Omaha: Approximately 1-3 times per year.

Required Qualifications

At least 5 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 3 years experience in provider contract negotiations in a managed health care setting ideally negotiating different provider contract @types (i.e. physician/group/hospital), or equivalent combination of relevant education and experience.

Working familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: value-based payment (VBP), fee-for service (FFS), capitation and various forms of risk, etc.

Negotiation and relationship building capabilities.

Ability to navigate complex regulatory environments.

Data-driven decision-making skills, and analytical abilities.

Organizational skills and attention to detail.

Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.

Ability to manage multiple tasks and deadlines effectively.

Effective verbal and written communication skills.

Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

Contracting experience with integrated delivery systems, hospitals and groups (specialty and ancillary).

Experience with Medicaid, Medicare, and Marketplace government-sponsored programs.

MS Excel (Pivot tables and VLookup)

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $69,447 - $142,548 / ANNUAL

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

Similar Jobs

Client Site Liaison II (Laboratory Send Outs Technician)

ARUP Laboratories • Omaha, NE • 35min ago

Hospital & Medical

Hourly Range: $20.03 USD to $28.08 USD Description Schedule: Monday - Friday (40 hrs/wk)7:30 AM - 4:00 PM Department: Client Site Liaisons - 916 Primary Purpose: This position works at the client site Physicians Laborato...

35min ago

Go to Apply

Dental Assistant - Entry Level

Aspen Dental • Council Bluffs, IA • 1h ago

Hospital & Medical

At Aspen Dental, we put You First, offering the security and job stability that comes with working with a world-class dental service organization (DSO). Our best-in-class training program, generous benefits package, and...

1h ago

Go to Apply

Endoscopy Account Manager - Lincoln/Omaha, NE

Olympus Corporation of the Americas • Omaha, NE • 1h ago

Hospital & Medical

Working Location: Nebraska, Omaha; Nebraska, Lincoln Workplace Flexibility: Field For more than 100 years, Olympus has focused on making people's lives healthier, safer and more fulfilling. ? ? ? Every day, we live by ou...

1h ago

Go to Apply

Physical Therapist

Veterans Affairs, Veterans Health Administration • Papillion, NE • 8h ago

Hospital & Medical

Summary The Physical Therapist serves as a clinician within Physical Medicine & Rehabilitation Services (PM&RS). Clinical responsibilities include independent chart review, complex physical therapy evaluations, e...

8h ago

Go to Apply

Health Plan Provider Contracts Manager - Complex

Molina Healthcare • Omaha, NE • 1d ago

Hospital & Medical

JOB DESCRIPTION Job Summary Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and development with respect to adequacy, financial...

1d ago

Go to Apply

Physical Therapist PRN

Catholic Health Initiatives • Omaha, NE • 1d ago

Hospital & Medical

Job Summary and Responsibilities As our Acute Care Physical Therapist at CHI Health Immanuel, you'll help our patients rebuild or maintain their physical wellbeing following an illness, injury, or issues with aging. Usin...

1d ago

Go to Apply

Retail Pharmacy Intern

Hy-Vee Food Stores • Omaha, NE • 2d ago

Hospital & Medical

Additional Considerations (if any): - 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 engaged and committed to supporting o...

2d ago

Go to Apply

$60/HR - Speech Language Pathologist - Schools (26-27)

Amergis • Ralston, NE • 2d ago

Hospital & Medical

The Speech-Language Pathologist in the school setting is responsible for performing student evaluations as well as providing and documenting therapy services in accordance with the plan of care developed for each individ...

2d ago

Go to Apply

$60/HR - Speech Language Pathologist - Schools (2026-2027)

Amergis • Bellevue, NE • 2d ago

Hospital & Medical

2d ago

Go to Apply

Medical Assistant

Rite of Passage • Omaha, NE • 2d ago

Hospital & Medical

Rate: $19 USD per hour Description ?Join a group of passionate advocates on our mission to improve the lives of youth! Rite of Passage Team is hiring for a Medical Assistant at Uta Halee Academy in Omaha, Nebraska? Uta H...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)