Health Plan Provider Contracts Mgr - Complex (Behavioral Health - New York)

Molina Healthcare; New York (NY); Sur place; USD 73 000 - 171 000; Plein temps

Résumé du poste

Molina Healthcare in New York seeks a senior contract professional to provide subject matter expertise and leadership for health plan provider network contracting activities. You will negotiate and manage agreements with hospitals, IPAs, behavioral health entities, and ancillary providers, directing complex reimbursement models and ensuring regulatory compliance.

Responsibilities include driving network adequacy, conducting financial impact analyses, and developing contracts in management

Qualifications

• At least 5 years of network contracting experience with large provider groups.
• 3+ years negotiating provider contracts in managed care (physician/group/hospital).
• Familiar with Medicaid/Medicare compensation methodologies and VBP/FFS/capitation.

Responsabilités

• Negotiate contracts with behavioral health providers and large networks.
• Execute, manage, and optimize provider contracts and re-contracts.
• Analyze financial impact of deal terms and justify for exec approval.
• Develop provider contracts in contract management systems and support PADU guidelines.
• Engage providers, renegotiate rates/language, and assist with cost-control strategies.
• Educate internal customers on contract terms and payment structures.
• Travel within New York state approximately 3–10%.

Connaissances

Negotiation

Data-driven decisions

Analytical skills

Communication

Organizational skills

Cross-functional teamwork

Attention to detail

Outils

Microsoft Office

Contract management software

Docusign

Salesforce

Description du poste

JOB DESCRIPTION

***This position will support Molina's New York state healthplan****

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 but not limited to: hospitals, independent physician associations (IPAs), and behavioral health organizations. OMH and OASAS, Ancillary facilities and Out of Network Providers.

Essential Job Duties

• Negotiates contracts with Behavioral Health Provider within 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 provider contracts.
• Knowledge of contracting reimbursements methodology, including but not limitied to Medicaid/Medicare Fee schedule, APG, Case Rates and Per Diems.
• 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.
• Advises 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.
• Approximately 3-10% travel within the state of New York
• Ability to work independently with minimal supervision to complete daily objectives

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.
• Behavioral Health experience highly preferred.
• Experience with Docusign, salesforce, MS Office and contract management software.

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 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.