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

Molina Healthcare

Long Beach (CA)

Remote

USD 65,000 - 100,000

Full time

17 days ago

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Job summary

An established industry player is seeking a skilled professional to enhance their provider network contracting. This role involves negotiating contracts with complex providers, ensuring compliance with regulations, and developing strategies to improve network adequacy. The ideal candidate will have significant experience in healthcare contract negotiations and a strong understanding of provider compensation methodologies. Join a dynamic team where your expertise will directly impact the quality of care and operational performance in the healthcare sector. If you are passionate about making a difference in healthcare, this opportunity is for you.

Qualifications

  • 5-7 years in healthcare contract roles and provider negotiations.
  • Familiarity with value-based payment and risk models.

Responsibilities

  • Negotiate contracts with complex provider entities for high-quality networks.
  • Engage with providers for renegotiations and cost control strategies.

Skills

Healthcare Contract Negotiation
Provider Compensation Methodologies
Contract Management Software
Strategic Planning
Relationship Management

Education

Bachelor's Degree in Healthcare
Master's Degree in Related Field

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. These responsibilities align with Molina Healthcare's mission, values, and strategic plans, ensuring compliance with applicable regulations. The role involves negotiating agreements with strategic, complex providers such as hospitals, physician groups, and behavioral health providers.

Job Duties

  1. Negotiate contracts with complex provider entities to ensure high-quality, cost-effective, and marketable provider networks, including large-scale entities with customized reimbursement models.
  2. Execute standardized alternative payment contracts and manage escalations, network adequacy issues, joint committees, and delegation oversight.
  3. Negotiate high-priority provider contracts using PADU guidelines, focusing on increasing membership in value-based contracts.
  4. Maintain and develop provider contracts using contract management software.
  5. Recruit additional providers to improve member access and reduce grievances.
  6. Engage with providers for renegotiations and cost control strategies to improve the Medical Care Ratio (MCR).
  7. Advise network provider contract specialists on negotiations and maintain relationships with significant providers.
  8. Evaluate and strategize to meet network adequacy standards.
  9. Review contract language for compliance and collaborate with legal teams on revisions.
  10. Participate in fee schedule development and reimbursement model innovations, involving cross-departmental input.
  11. Educate internal teams on contract terms and communicate effectively with providers.
  12. Contribute to strategic planning and special projects within the department.
  13. Travel regularly within designated regions to meet contractual and network needs.

Job Qualifications

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

Required Experience/Skills:

  • 5-7 years in healthcare contract roles, including provider office, managed care, or similar environments.
  • At least 3 years in provider contract negotiations within managed healthcare, covering various provider types.
  • Familiarity with healthcare provider compensation methodologies, including value-based payment, fee-for-service, capitation, and risk models.

Preferred Education: Master's Degree in a related field or equivalent experience.

Preferred Experience: Over 3 years in provider network contracting.

Current Molina employees interested in this role should apply through the intranet. Molina Healthcare offers competitive benefits and is an Equal Opportunity Employer (EOE) M/F/D/V.

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