Provider Contracts Manager

Molina Healthcare; Long Beach (CA); Remote; USD 75,000 - 115,000; Full time

Job summary

An established industry player is seeking a skilled healthcare contract manager to develop and manage provider networks. This role is pivotal in negotiating agreements with hospitals and physician groups, ensuring operational efficiency and compliance with regulations. You will engage in strategic planning, manage contract negotiations, and contribute to innovative reimbursement models. If you have a passion for healthcare and a strong background in contract management, this is an exciting opportunity to make a significant impact in the healthcare landscape.

Qualifications

• 5-7 years in healthcare contract management with a focus on provider negotiations.
• Bachelor’s Degree in a healthcare-related field or equivalent experience.

Responsibilities

• Negotiate contracts with complex providers to ensure high-quality provider networks.
• Manage escalations and network adequacy assessments.

Skills

Healthcare Contract Management

Provider Negotiations

Medicaid and Medicare Payment Models

Contract Management Software

Education

Bachelor's Degree in Healthcare

Master's Degree

Tools

Contract Management Software

Job description

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

Job Description

Job Summary

Molina Health Plan Provider Network Contracting jobs are responsible for developing and managing the network strategy to ensure adequacy, financial performance, and operational efficiency. This is aligned with Molina Healthcare's mission, values, and strategic plans, while complying with all relevant regulations. The role involves negotiating agreements with complex providers, including hospitals, physician groups, and behavioral health providers, that are crucial to the success of the plan.

Job Duties

• Negotiate contracts with complex providers to ensure high-quality, cost-effective, and marketable provider networks, including custom reimbursement arrangements and standardized alternative payment contracts.
• Manage escalations, network adequacy assessments, joint operating committees, and delegation oversight.
• Negotiate complex provider contracts, focusing on high-priority physician groups and facilities, using PADU guidelines, with an emphasis on value-based relationships.
• Maintain and develop provider contracts using contract management software.
• Recruit new providers to improve member access and reduce grievances.
• Engage in rate renegotiations and language updates with contracted providers to support cost control and improve Medical Care Ratios.
• Advise network provider contract specialists and maintain relationships with significant providers.
• Assess and ensure provider network adequacy, compliance with standards, and regulatory requirements.
• Participate in fee schedule development and reimbursement model innovations, collaborating with corporate and legal teams.

Educate internal teams on contract terms and communicate effectively with providers.

• Contribute to strategic planning and special projects, including regional travel as needed.

Job Qualifications

• Required Education: Bachelor’s Degree in a healthcare-related field or equivalent experience.
• Required Experience/Skills: 5-7 years in healthcare contract management, including 3+ years in provider negotiations within managed care, with familiarity in Medicaid and Medicare payment models.
• Preferred Education: Master’s Degree or equivalent experience.
• Preferred Experience: 3+ years in provider network contracting.

For current Molina employees interested in this position, please apply through the intranet. Molina offers competitive benefits and is an Equal Opportunity Employer.