Director, Health Plan Provider Contracts (Nevada)

Molina Talent Acquisition; United States; On-site; USD 140,000 - 210,000; Full time

Job summary

Molina Healthcare is seeking a Senior Director of Provider Contracting in Nevada. You will oversee the provider contracting function, lead negotiations with complex providers, and ensure network adequacy for Medicare, Marketplace, and Medicaid.

You will develop contracting strategies, including VBP, and collaborate with senior leadership to meet organizational goals, while maintaining compliance and using standardized templates.

Qualifications

• 8+ years in network/provider contracting within managed health care.
• 3+ years of management/leadership experience.
• Experience across Medicaid/Medicare, VBP, FFS, capitation.

Responsibilities

• Oversees the plan’s provider contracting function and daily operations.
• Leads negotiations of contracts with complex provider groups.
• Manages and reports network adequacy for Medicare, Marketplace, and Medicaid.
• Develops contracting strategies including VBP; identifies target specialties/geographies.
• Ensures compliance with regulatory requirements and uses standard templates.

Skills

Negotiation leadership

Provider contracting

Regulatory compliance

Cross-functional collaboration

Data-driven decision making

Communication skills

Project management

Job description

JOB DESCRIPTION Job Summary

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