Provider Contracts Manager (Must reside in Georgia)

Molina Healthcare; Georgia; Remote; USD 66,000 - 130,000; Full time

Job summary

A leading healthcare provider is seeking a Contract Manager to handle provider network contracting strategies. This remote position requires candidates to have significant experience in negotiating healthcare contracts and working with various compensation methodologies. The ideal applicant will have a Bachelor’s in a healthcare field and extensive experience in managed care environments.

Benefits

Competitive benefits and compensation package

Equal Opportunity Employer

Qualifications

• 5-7 years contract-related experience in the health care field.
• 3+ years experience in provider contract negotiations.
• Master's Degree in a related field preferred.

Responsibilities

• Negotiate contracts with Complex Provider Community.
• Manage issue escalations and network adequacy.
• Participate in fee schedule determinations.

Skills

Contract negotiation skills

Strong communication skills

Knowledge of healthcare compensation methodologies

Education

Bachelor’s Degree in a healthcare related field

Job description

Overview

Remote and must live in Georgia.

Job Description

Job Summary

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, 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. Negotiates agreements with Complex providers who are strategic to the success of the Plan, including but not limited to Hospitals, Independent Physician Association, and complex Behavioral Health arrangements.

Job Duties

• Negotiate 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.
• Execute standardized Alternative Payment Method contracts.
• Manage issue escalations, network adequacy, Joint Operating Committees, and delegation oversight.
• Maintain a tightly knit ongoing relationship after contract execution.
• In conjunction with Director/Manager, Provider Contracts, negotiate Complex Provider contracts including but not limited to high priority physician group and facility contracts using PADU (Preferred, Acceptable, Discouraged, Unacceptable) guidelines. Emphasis on membership in Value Based Relationship Contracts.
• Develop and maintain provider contracts in contract management software.
• Target and recruit additional providers to reduce member access grievances.
• Engage targeted contracted providers in renegotiation of rates and/or language. Assist with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.
• Advise Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
• Maintain contractual relationships with significant/highly visible providers.
• Evaluate provider network and implement strategic plans to meet Molina’s network adequacy standards.
• Assess contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
• Participate in fee schedule determinations including development of new reimbursement models. Seek input on new reimbursement models from Corporate Network Management, legal and VP level engagement as required.
• Educate internal customers on provider contracts.
• Clearly and professionally communicate contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.
• Participate with the management team and other committees addressing the strategic goals of the department and organization.
• Participate in other contracting related special projects as directed.
• Travel regularly throughout designated regions to meet targeted needs.

Job Qualifications

REQUIRED EDUCATION:

• Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 5-7 years contract-related experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care environment.
• 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.
• Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee-for-service, capitation and various forms of risk, ASO, etc.

PREFERRED EDUCATION:

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

PREFERRED EXPERIENCE:

• 3+ years in Provider Network contracting

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.

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Pay Range: $66,456 - $129,590 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.