Health Plan Provider Contracts Manager - Complex (Texas)

Molina Healthcare; Dallas (TX); On-site; USD 73,000 - 143,000; Full time

Job summary

Molina Healthcare is seeking a seasoned professional to lead health plan provider network contracting efforts, negotiating complex hospital, IPA, and behavioral health agreements. You will support network strategy, drive value-based payment models, and oversee contract management processes in a highly matrixed organization.

The role requires extensive negotiation experience, data-driven decision making, and the ability to travel within Texas up to 25% to centers in Central and Northeast Texas.

Qualifications

• At least 5 years of experience in network contracting with large multispecialty provider groups.
• Experience in provider contract negotiations in a managed health care setting.
• Familiarity with Medicaid, Medicare, and Marketplace programs and value-based payment models.
• Strong negotiation and relationship-building capabilities.
• Ability to navigate complex regulatory environments.
• Data-driven decision-making and analytical abilities.

Responsibilities

• Negotiate contracts with the complex provider community to secure high quality, cost-effective plan providers.
• Manage contracts including AP M contracts and delegation oversight.
• Execute value-based contracts and provider relationship management.
• Analyze financial impact of deal terms and prepare support for executive approval.
• Develop and maintain provider contracts in contract management software.
• Recruit additional providers to reduce member access grievances.
• Engage providers in renegotiation of rates and terms; support cost-control strategies.
• Educate internal customers on contract terms, payment structures, and reimbursement rates.
• Travel up to 25% within Texas (Central & NE Texas).

Skills

Negotiation

Relationship building

Data-driven decisions

Analytical skills

Cross-functional teamwork

Communication skills

Microsoft Office

Tools

Microsoft Office

Job description

JOB DESCRIPTION

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: hospitals, independent physician associations (IPAs), and behavioral health organizations.

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 standardizedalternative 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.
• Advise 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 up to 25% within Texas - mostly Central & NE Texas

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.