Health Plan Ancillary Provider Contracts Manager - Complex (Michigan)

Molina Healthcare • Grand Rapids, MI • 5h ago

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: Skilled Nursing Facility, Lab, DME, Dialysis, etc

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.

Travels regularly throughout designated regions to meet targeted needs.

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.

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: $73,102 - $142,549 / ANNUAL

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

Similar Jobs

Financial Services - Technology Consulting - Product Operating Model Transformation - Manager

EY • Grand Rapids, MI • 1h ago

Hospital & Medical

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...

1h ago

Go to Apply

Nurse Tech Weekend Only

Corewell Health • Grand Rapids, MI • 2h ago

Hospital & Medical

On-site Grand Rapids, MI Part time R228435 About the unit 3D is a Medical-Surgical unit located at Blodgett Hospital that is dedicated to care for complex medical patients as well as being distinguished as a Primary Stro...

2h ago

Go to Apply

Nurse Tech Med Surg

Corewell Health • Grand Rapids, MI • 1d ago

Hospital & Medical

On-site Grand Rapids, MI Part time R227861 About the unit We provide inpatient bedside care for mainly the General Medical Patient Population, which could be patients with a wide variety of diagnoses, pneumonia, cellulit...

1d ago

Go to Apply

Nurse Tech Med Surg

Corewell Health • Grand Rapids, MI • 1d ago

Hospital & Medical

On-site Grand Rapids, MI Part time R227871 About the unit We provide inpatient bedside care for mainly the General Medical Patient Population, which could be patients with a wide variety of diagnoses, pneumonia, cellulit...

1d ago

Go to Apply

Ambulatory Clinical Tech Gynecological Surgical Specialties

Corewell Health • Grand Rapids, MI • 1d ago

Hospital & Medical

On-site Grand Rapids, MI Full time R227158 About Outpatient Clinics Corewell Health operates over 300 outpatient clinics across Michigan, bringing a multitude of care options to the communities that we serve. There are o...

1d ago

Go to Apply

Medical Assistant Internal and Pediatrics

Corewell Health • Grandville, MI • 1d ago

Hospital & Medical

On-site Grandville, MI Full time R228018 Corewell Health is offering a $3,000 sign-on bonus for this opportunity! Sign-On Bonus for External applicants or current CHW MA Apprentice Students only Practice Overview This is...

1d ago

Go to Apply

Medical Assistant Heart and Vascular

Corewell Health • Grand Rapids, MI • 1d ago

Hospital & Medical

On-site Grand Rapids, MI Wyoming, MI Full time R227984 Corewell Health is offering a $3,000 sign-on bonus for this opportunity! Sign-On Bonus for External applicants or current CHW MA Apprentice Students only About the U...

1d ago

Go to Apply

Medical Assistant Urgent Care

Corewell Health • Grand Rapids, MI • 1d ago

Hospital & Medical

On-site Grand Rapids, MI Full time R228237 Corewell Health is offering a $3,000 sign-on bonus for this opportunity! Sign-On Bonus for External applicants or current CHW MA Apprentice Students only About the Unit You neve...

1d ago

Go to Apply

Physical Therapist Inpatient Peds PRN

Corewell Health • Grand Rapids, MI • 1d ago

Hospital & Medical

On-site Grand Rapids, MI Part time R228380 Scope of Work Provides therapy to patients based on patient need and medical direction. Provides patient/caregiver education and arranges for adaptive equipment as needed. Stand...

1d ago

Go to Apply

Medical Technologist, 0 FTE

Trinity Health • Grand Rapids, MI • 2d ago

Hospital & Medical

Employment Type: Part time Shift: Rotating Shift Description: Medical Technologist Great opportunity for a Medical Technologist professional to work in an organization that focuses on treating the whole person, physicall...

2d ago

Go to Apply

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