Manager, Provider Contracts

Molina Healthcare; City of Albany (NY); Remote; USD 77,000 - 172,000; Full time

Job summary

An established industry player is seeking a skilled professional to manage provider contracting and maintain critical provider information. This role involves developing health plan-specific strategies, ensuring compliance with network adequacy requirements, and implementing cost control initiatives to positively influence the Medical Care Ratio. The ideal candidate will have a strong background in provider contracting, data validation, and financial strategy development. Join a forward-thinking organization that values innovation and offers a competitive benefits package while making a significant impact on healthcare delivery.

Qualifications

• 5-7 years of experience in provider contracting and network management.
• Bachelor's degree required; graduate degree preferred.

Responsibilities

• Develops provider contracting strategies to build a sufficient network.
• Ensures compliance with provider panel and network capacity requirements.
• Monitors financial exposure and adjusts strategies as needed.

Skills

Provider Contracting Strategies

Cost Control Initiatives

Contract Compliance

Reimbursement Models

Data Validation

Education

Bachelor's Degree in Business Administration

Graduate Degree

Job description

***Remote and must live in the United States***

Job Description

Job Summary
Molina National Level Contracting jobs are responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and applies business rules as they pertain to each database. Validates data to be housed on provider databases and ensures adherence to business and system requirements of customers as it pertains to contracting, network management, and credentialing.

Knowledge/Skills/Abilities

1. In conjunction with the Director, Provider Contracts, develops health plan-specific provider contracting strategies, identifying specialties and geographic locations on which to concentrate resources for establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members.
2. Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, MLTSS, and other health care providers.
3. Assists in achieving annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
4. Utilizes standardized contract templates and Pay for Performance strategies.
5. Utilizes established Reimbursement Tolerance Parameters (across multiple specialties/geographies). Oversees the development of new reimbursement models in concert with Director.
6. Oversees the maintenance of all Provider and payer Contract Templates. Works with legal and Corporate Network Management on an as-needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
7. Ensures compliance with applicable provider panel and network capacity, adequacy requirements, and guidelines. Produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
8. Develops and implements strategies to minimize the company's financial exposure. Monitors and adjusts strategy implementation as needed to achieve desired goals and minimize the company's financial exposure.

Job Qualifications

Required Education
Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.
Required Experience
5-7 years.
Preferred Education
Graduate degree.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.