Provider Contracts Manager

Molina Healthcare; Grand Rapids (MI); Remote; USD 66,000 - 130,000; Full time

Job summary

A leading company is seeking a qualified candidate to manage provider contracts and negotiations in Michigan. Responsibilities include developing new reimbursement models and ensuring compliance with corporate standards. The role requires a Bachelor’s degree in a healthcare-related field and significant experience in contract management, targeting improvements in network adequacy and quality of care.

Benefits

Competitive benefits package

Equal Opportunity Employer (EOE)

Qualifications

• 5-7 years of experience in contract negotiation and management.
• Experience in healthcare is preferred.

Responsibilities

• Negotiate high priority physician group and facility contracts.
• Develop and maintain provider contracts.
• Maintain relationships with significant providers.

Skills

Negotiation

Contract Management

Strategic Planning

Compliance Evaluation

Cost Control Strategies

Education

Bachelor's Degree in a healthcare related field

Graduate degree

Tools

APTTUS contract management software

Job description

***Remote and must live in Michigan***

JOB DESCRIPTION

Job Summary

Negotiates agreements with highly visible providers including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.

KNOWLEDGE/SKILLS/ABILITIES

• In conjunction with Director/Manager Provider Contracts, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
• Develops and maintains provider contracts in APTTUS 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 Care Ratio (MCR) within each region.
• Maintains contractual relationships with significant/highly visible providers.
• Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.
• 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 MHI attorney.
• Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal.
• Educates internal customers on provider contracts.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in a healthcare related field or an equivalent combination of education and 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: $66,456 - $129,590 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.