Health Plan Provider Contracts Leader — Value-Based Networks

Socket.dev; Long Beach (CA); On-site; USD 120,000 - 170,000; Full time

Job summary

Molina Healthcare in California seeks a senior Network Contracting leader to negotiate complex agreements with large specialty and multispecialty provider groups. You will drive value-based payment models, manage contract terms, and guide regional strategies to meet network adequacy and cost targets.

You will develop and maintain contracts, oversee PADU guidelines, and coordinate with corporate counsel on regulatory compliance.

Qualifications

• At least 5 years of network contracting experience with large provider groups.
• 3+ years negotiating provider contracts in managed care.
• Familiar with Medicaid/Medicare pay models like VBP, FFS, capitation.
• Strong negotiation and relationship-building skills.
• Ability to navigate complex regulatory environments and data-driven decisions.

Responsibilities

• Negotiate 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; execute standardized alternative payment model (APM) contracts; support oversight.
• Execution, management, and optimization of value-based contracts and provider relationship management.
• Analyze financial impact of deal terms and prepare for executive approval for agreements outside Molina guidelines.
• Develops and maintains provider contracts in contract management software.
• Targets and recruits providers to reduce member access grievances.
• Engages in renegotiation of rates/language; assist with cost-control strategies affecting MCR.
• Educates internal customers on provider contracts.
• Communicates contract terms and rates to providers.

Skills

Negotiation

Contract management

Data analysis

Regulatory knowledge

Communication

Tools

MS Office

Contract software

Job description

Molina Healthcare in California seeks a senior Network Contracting leader to negotiate complex agreements with large specialty and multispecialty provider groups. You will drive value-based payment models, manage contract terms, and guide regional strategies to meet network adequacy and cost targets.

You will develop and maintain contracts, oversee PADU guidelines, and coordinate with corporate counsel on regulatory compliance.