Provider Contracts Manager (Remote in MS)

Lensa; Gulfport (MS); Remote; USD 59,000 - 130,000; Full time

Job summary

A leading company in the healthcare sector is seeking a Provider Contracts Manager to negotiate and manage contracts with key providers. This remote role requires a Bachelor's degree in a healthcare-related field and extensive experience in provider contract negotiations. The successful candidate will ensure compliance with standards and enhance provider relationships, contributing to the overall success of the healthcare plan.

Qualifications

• 5-7 years in healthcare contract-related roles.
• 3+ years in provider contract negotiations.
• Familiarity with managed care provider compensation methodologies.

Responsibilities

• Negotiate contracts with complex providers.
• Develop and maintain provider contracts.
• Engage in renegotiation of rates and contract language.

Skills

Contract Negotiation

Provider Relations

Healthcare Regulations

Cost Control Strategies

Education

Bachelor's Degree in a healthcare-related field

Master's Degree or equivalent experience

Job description

Provider Contracts Manager (Remote in MS)

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Remote and must live in Mississippi

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 regulations.

Negotiates agreements with complex providers who are strategic to the success of the plan, including hospitals, Independent Physician Associations, and behavioral health arrangements.

Job Duties

• Negotiate contracts with the complex provider community to ensure high quality, cost-effective, and marketable providers, including large-scale entities with custom reimbursement arrangements.
• Develop and maintain provider contracts in contract management software.
• Target and recruit additional providers to improve member access and reduce grievances.
• Engage in renegotiation of rates and contract language with targeted providers, assisting with cost control strategies to improve Medical Care Ratio.
• Advise Network Provider Contract Specialists on negotiation strategies.
• Maintain relationships with significant providers and evaluate network adequacy.
• Ensure contract language compliance with standards and regulations, reviewing with legal counsel as needed.
• Participate in fee schedule development and new reimbursement models, seeking input from relevant stakeholders.
• Educate internal teams on provider contract details.
• Communicate contract terms clearly and professionally to providers.
• Participate in strategic planning and special projects, including travel within designated regions.

Job Qualifications

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

Required Experience/Skills:

• 5-7 years in healthcare contract-related roles.
• 3+ years in provider contract negotiations, including physician, group, and hospital contracts.
• Familiarity with managed care provider compensation methodologies, including Value Based Payment, fee-for-service, capitation, and risk arrangements.

Preferred Education: Master's Degree or equivalent experience.

Preferred Experience: 3+ years in provider network contracting.

To apply, current Molina employees should use the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Additional Details

• Pay Range: $59,811 - $129,589.63 annually
• Seniority Level: Mid-Senior level
• Employment Type: Contract
• Job Function: Management and Manufacturing