Health Plan Provider Contracts Manager - Complex

Molina Healthcare • Grand Island, NE • 2d 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

Health Market Clerk

Hy-Vee Food Stores • Grand Island, NE • 4d 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...

4d ago

Go to Apply

Physical Therapist

Veterans Affairs, Veterans Health Administration • Grand Island, NE • 1w 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...

1w ago

Go to Apply

Medical Social Worker

CommonSpirit Health at Home • Grand Island, NE • 1w ago

Hospital & Medical

Job Summary and Responsibilities At (Company Name), we strive to embody our mission of delivering hope and healing to those we serve. As a Medical Social Worker , you'll engage in a range of exciting responsibilities, in...

1w ago

Go to Apply

Staff Nurse - RN

Good Samaritan • Central City, NE • 1w ago

Hospital & Medical

Create Your Career With Us! Join our not-for-profit organization that has provided over 100 years of housing and services to seniors with a commitment to quality care and service in a Christian environment. Location: Lit...

1w ago

Go to Apply

Registered Nurse - Community Living Center

Veterans Affairs, Veterans Health Administration • Grand Island, NE • 3w ago

Hospital & Medical

Summary The Grand Island VA Community Living Center (CLC), Registered Nurses (RNs) are at the heart of everything we do. You'll have the unique opportunity to build lasting connections with Veterans, provide hands-on car...

3w ago

Go to Apply

Registered Nurse - Residential Rehabilitation Treatment Program

Veterans Affairs, Veterans Health Administration • Grand Island, NE • 3w ago

Hospital & Medical

Summary This is an OPEN CONTINUOUS ANNOUNCEMENT and will remain open until July 9, 2026 or until all vacancies have been filled. Eligible applications will be referred at regular intervals or as additional vacancies occu...

3w ago

Go to Apply

Deli Production Team Member

Pilot Company • Wood River, NE • 6h ago

Retail & Hospitality

Company Description Pay Rates Starting between: $15.00 - $17.85 / hour Are you passionate about team building, customer service, and meeting new people? Pilot Company offers a dynamic environment where no two days are th...

6h ago

Go to Apply

Customer Service Representative

U-Haul • Grand Island, NE • 16h ago

Management & Administrative

Location: 1730 S Locust, Grand Island, Nebraska 68801 United States of America Are you a people person? Do you love helping others? U-Haul is in search of friendly, motivated people for the position of Customer Service R...

16h ago

Go to Apply

(USA) Member Team Lead

Walmart • Grand Island, NE • 20h ago

Retail & Hospitality

Position Summary... What you'll do... Assists management with the supervision of associates in assigned area of responsibility by assigning duties to associates communicating goals and feedback training associates on pro...

20h ago

Go to Apply

(USA) Asset Protection Operations Coach

Walmart • Grand Island, NE • 2d ago

Position Summary... What you'll do... Drives sales by ensuring effective merchandise presentation for example accurate and competitive pricing proper signing inventory levelscleanliness of the area assessing economic tre...

2d ago

Go to Apply

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