Director, Health Plan Provider Contracts (Nevada)

Molina Healthcare; Carson City (NV); On-site; USD 102,000 - 199,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare in Carson City, NV seeks a Senior Manager, Network Contracting to lead the provider contracting team and advance strategic, value-based payment initiatives. You will negotiate complex hospital and IPA contracts, develop standardized templates, and ensure regulatory compliance while targeting cost efficiency and network adequacy.

This role requires extensive Medicaid/Medicare experience, strong analytics, and leadership to align contracting with corporate goals and performance

Qualifications

• At least 8 years in network contracting with large specialty or multispecialty provider groups.
• At least 5 years of provider contract negotiation in a managed care setting.
• Minimum 3 years of management/leadership experience.
• Experience with Medicaid/Medicare/Marketplace compensation methodologies including VBP, FFS, capitation.
• Excellent negotiation and relationship-building capabilities.
• Strong data-driven decision-making and analytical abilities.
• Ability to navigate complex regulatory environments.
• Strong organizational skills and attention to detail.
• Ability to work cross-functionally in a matrixed organization.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office and related software.

Responsibilities

• Oversees the plan’s provider contracting function and collaborates with stakeholders to lead or support contracting activities.
• Leads negotiations of contracts with complex providers to deliver high-quality, cost-effective agreements.
• Executes standardized APM or VBP contracts and recontracting initiatives.
• Leads initiatives, issue escalations, network adequacy, and JOCs.
• Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.
• Oversees development of provider contracting strategies including VBP across specialties and geographies.
• Leads annual savings through recontracting initiatives and cost-control measures to influence MCR.
• Negotiates provider contracts in alignment with company guidelines for physicians, hospitals, and other providers.
• Maintains contract templates and SAP/VBP program templates with legal and leadership input.
• Develops and implements new reimbursement models in collaboration with senior leadership.
• Communicates contracting strategies to network leadership and tracks activity with standardized systems.
• Participates in senior leadership committees to address department and organizational goals.

Skills

Negotiation

Leadership

Data-driven decisions

Regulatory navigation

Cross-functional collaboration

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Leads and directs team responsible for health plan provider network contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Collaborates with senior leadership and the corporate network management team to develop and implement standardized provider contracts and contracting strategies. Also responsible for negotiating complex contracts that are strategically critical to plan success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements.

Work Location

- Nevada

Essential Job Duties

• Oversees the plan’s provider contracting function; responsible for leading the daily operations of the department, and collaborating with other operational departments and functional business unit stakeholders to lead or support various provider contracting functions.
• Leads negotiations of contracts with the complex provider community that result in high quality, cost-effective and marketable providers.
• Contracts/re-contracts with large scale entities involving custom reimbursement; executes standardized alternative payment model (APM) or value-based payment (VBP) contracts.
• Leads initiatives and activities issue escalations, network adequacy, and joint operating committees (JOCs).
• Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.
• In conjunction with network leadership, oversees the development of provider contracting strategies including VBP; includes identifying those specialties and geographic locations to concentrate resources for purposes of establishing a sufficient network of participating providers to serve the health care needs of members, in addition to identifying VBP provider targets to meet Molina goals.
• Leads the achievement of annual savings through recontracting initiatives, and implements cost-control initiatives to positively influence the medical cost ratio (MCR) in each contracted region.
• Leads preparation and negotiations of provider contracts and oversees negotiation of contracts, including VBP, in alignment with established company guidelines for contracting with physicians, hospitals, and other health care providers.
• Utilizes standardized contract templates and VBP/pay-for-performance (P4P) strategies.
• Develops and maintains reimbursement tolerance parameters (across multiple specialties/ geographies); oversees the development of new reimbursement models in collaboration with senior leadership.
• Communicates new contracting strategies to corporate provider network leadership.
• Utilizes standardized systems to track contract negotiation activity on an ongoing basis.
• Participates on the senior leadership and other committees to address the strategic goals of the department and organization.
• Oversees the maintenance of all provider contract templates including VBP program templates; collaborates with legal and corporate network leadership to modify contract templates, and ensures compliance with all contractual and/or regulatory requirements.
• Manages the contracting relationships with area agencies and community partners to support and advance plan initiatives.
• Develops and implements contracting strategies to comply with state, federal, National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS) initiatives and regulations.
• Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration.

Required Qualifications

• At least 8 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 5 years experience in provider contract negotiations in a managed health care setting ideally negotiating complex provider contract types and value-based payment (VBP) models (i.e. physician/group/hospital), or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Experience 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.
• Excellent negotiation and relationship building capabilities.
• Ability to navigate complex regulatory environments.
• Strong data-driven decision-making skills, and analytical abilities.
• Strong 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.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Deep experience negotiating alternative payment models (APMs).
• Experience with Medicaid, Medicare, and Marketplace government-sponsored programs.

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

Pay Range: $102,163 - $199,219 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.