Provider Contracts Manager HP - Complex (Remote - Must Reside in New Mexico)

Home Health Focus; California (MO); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a skilled contract negotiator to join their dynamic team. This role focuses on developing and executing network strategies to enhance provider networks, ensuring compliance and operational performance. Responsibilities include negotiating contracts with various healthcare providers, managing relationships, and implementing strategic plans to improve network adequacy. The ideal candidate will have a strong background in healthcare contracting and a passion for enhancing member access. Join a forward-thinking organization that values innovation and excellence in healthcare delivery.

Qualifications

• 5-7 years of contract-related experience in healthcare.
• 3+ years of provider contract negotiation experience.

Responsibilities

• Negotiate contracts for physician groups and facilities.
• Maintain relationships with significant providers.
• Participate in strategic management and special projects.

Skills

Contract negotiation

Provider relationship management

Healthcare compensation methodologies

Contract management software

Education

Bachelor's Degree in healthcare-related field

Master's Degree or equivalent experience

Tools

Contract management software

Job description

Job Description

Job Summary

Molina Health Plan Provider Network Contracting roles are responsible for developing and executing network strategies related to adequacy, financial, and operational performance, aligning with Molina Healthcare's mission, values, and strategic plan, while ensuring compliance with relevant regulations. This includes negotiating agreements with strategic complex providers such as hospitals, Independent Physician Associations, and behavioral health providers.

Job Duties

This position involves negotiating contracts with complex provider communities to ensure high-quality, cost-effective, and marketable provider networks. Responsibilities include contract negotiations with large entities, executing standardized alternative payment contracts, managing escalations, ensuring network adequacy, participating in joint operating committees, and overseeing delegation processes. The role also involves ongoing relationship management after contract execution.

Key responsibilities include:

1. Negotiating contracts for high-priority physician groups and facilities using PADU guidelines, with an emphasis on increasing membership in value-based contracts.
2. Developing and maintaining provider contracts using contract management software.
3. Targeting and recruiting providers to improve member access and reduce grievances.
4. Engaging providers in rate renegotiations and language updates, supporting cost control strategies to improve the Medical Care Ratio.
5. Advising network provider contract specialists on negotiations.
6. Maintaining relationships with significant providers.
7. Evaluating network adequacy and implementing strategic plans to meet standards.
8. Reviewing contract language for compliance and working with legal counsel as needed.
9. Participating in fee schedule development and reimbursement model innovation.
10. Educating internal teams on contract terms and reimbursement structures.
11. Communicating effectively with providers regarding contract details.
12. Participating in strategic management and special projects, including regular regional travel.

Job Qualifications

Required Education: Bachelor's Degree in a healthcare-related field or equivalent experience.

Required Experience/Skills:

• 5-7 years of contract-related experience in healthcare settings.
• 3+ years of provider contract negotiation experience, including various provider types.
• Familiarity with healthcare provider compensation methodologies, especially in Medicaid and Medicare, such as value-based payment, fee-for-service, capitation, and risk models.

Preferred Education: Master's Degree or equivalent experience.

Preferred Experience: Over 3 years in provider network contracting.

Current Molina employees interested in this role should apply via the intranet. Molina Healthcare offers competitive benefits and is an Equal Opportunity Employer.