Provider Contracts Manager
Company: Molina Healthcare
Location: Richmond
Posted on: May 7, 2024
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Job Description:
***Remote and must live in Virginia***
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.
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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
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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
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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. -
#PJCorp Pay Range: $59,810.6 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level.
Keywords: Molina Healthcare, Chantilly , Provider Contracts Manager, Executive , Richmond, Virginia
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here to apply!
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