Manager, Value-Based Provider Contracts

Molina Healthcare; Cincinnati (OH); Remote; USD 73,000 - 143,000; Full time

Job summary

An established industry player is seeking a dynamic individual to lead the Provider Contracting team. In this pivotal role, you will manage complex contracts and negotiate with healthcare providers to ensure high-quality, cost-effective services. You will collaborate with various departments to develop innovative reimbursement models and strategies aimed at minimizing financial exposure. This role offers an exciting opportunity to contribute to the organization's mission while ensuring compliance with all regulatory requirements. If you are passionate about healthcare and have a proven track record in provider contracting, this position could be your next career move.

Qualifications

• 5-7 years experience in Healthcare Administration and Provider Contracting.
• 3+ years in provider contract negotiations in managed healthcare.

Responsibilities

• Manage Provider Contracting functions and negotiate contracts with providers.
• Develop VBP provider contracting strategies and oversee compliance.

Skills

Healthcare Administration

Provider Contracting

Negotiation Skills

Leadership

Managed Care

Education

Bachelor’s Degree in Business Administration

Master's Degree in a related field

Job description

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

Job Description

Job Summary

Molina Health Plan Provider Network Contracting jobs are responsible for the value-based payments (VBP) network strategy and development with respect to financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.

Responsible for contracting/re-contracting of Complex contracts with Alternative Payment Methods including but not limited to Value Based and Capitated payments for Hospitals, Independent Practice Associations, and complex Behavioral Health arrangements.

Manages VBP's through negotiation, implementation, and management. Entail value-based contracting negotiations and understanding of alternative arrangements. Maintains critical Complex provider information on claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Manages the exchange of data and reporting for all state-led VBP's.

Job Duties

Manages the Plan’s Provider Contracting functions and team members. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Contracting functions. This role negotiates contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract/Re-contracting with large scale entities involving custom reimbursement. Executes standardized Alternative Payment Method or Value Based Payment (VBP) contracts. The role manages VBP's from initiation and contracting through ongoing management activities including educations and performance reviews. Issue escalations, Joint Operating Committees, and delegation oversight.

1. In conjunction with Director, Provider Contracts, develops health plan-specific VBP provider contracting strategies. This includes identifying VBP provider targets and assist with the development of VBC models to meet Molina goals.
2. Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, MLTSS and other health care providers.
3. Utilizes established Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with Director.
4. 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.
5. Ensures compliance with applicable APM requirements and guidelines. Produces and monitors reports on a recurring basis to track and monitor compliance with APM requirements.
6. Manages the exchange of data and reporting for all state-led VBP's to ensure timely and accurate exchange.
7. Develops and implements strategies to minimize the company’s financial exposure. Monitors and adjusts strategy implementation as needed to achieve desired goals and reduce the company’s financial exposure.
8. Assesses contract language for compliance with Corporate standards and regulatory requirements and reviews revised language with assigned MHI attorney.
9. Participates in development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management, legal and VP level engagement as required.
10. Educates internal customers on provider contracts.
11. Participates on the management team and other committees addressing the strategic goals of the department and organization.
12. Manages and provides coaching to Network Contracts Staff.
13. Manages and evaluates team member performance; provides coaching, consultation, employee development, and recognition; ensures ongoing, appropriate staff training; holds regular team meetings to drive good communication and collaboration; and has responsibility for the selection, orientation and mentoring of new staff.

Job Qualifications

REQUIRED EDUCATION:

Bachelor’s Degree in a related field (Business Administration, etc.) or equivalent experience.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

1. 5-7 years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position.
2. 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, group and hospital contracting, etc.
3. Working experience with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc.
4. Min. 2 years experience managing/supervising employees.

PREFERRED EDUCATION:

Master's Degree in a related field or an equivalent combination of education and experience.

PREFERRED EXPERIENCE:

Experience Negotiating Alternative Payment Methods.

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.

#PJCorp

Pay Range: $73,102 - $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.