Senior Ancillary Provider Contracts Lead (VBP)

Molina Talent Acquisition; Flint (MI); On-site; USD 120,000 - 160,000; Full time

Job summary

Molina Healthcare in Michigan seeks a senior leader to manage health plan provider network contracting. You will negotiate complex agreements, including value-based models, with physician groups, hospitals and ancillary providers across Medicaid/Medicare lines.

The role requires deep regulatory acumen, strong negotiation and relationship-building skills, and the ability to drive network adequacy and financial performance while working across a matrixed organization. Travel will be regional.

Qualifications

• 5+ years in network contracting with large specialty or multispecialty provider groups.
• 3+ years in provider contract negotiations in a managed health care setting.
• Experience negotiating different provider contract types (physician/group/hospital).
• Knowledge of Medicaid/Medicare value-based payment, FFS, capitation, and risk.
• Strong negotiation and relationship-building capabilities.
• Ability to navigate complex regulatory environments.
• Data-driven decision-making and analytical abilities.
• Excellent organizational skills and attention to detail.
• Ability to work cross-functionally in a matrixed organization.
• Ability to manage multiple tasks and deadlines.

Responsibilities

• Negotiate contracts and letters of agreement with complex provider groups to secure high quality, cost-effective plan providers.
• Contract and re-contract with large-scale entities involving custom reimbursement and alternative payment models.
• Execute and optimize value-based contracts and provider relationships.
• Analyze financial impact of deal terms and prepare justification for executive approval.
• Negotiate complex contracts using PADU guidelines with priority provider groups.
• Develop and maintain provider contracts in contract management software.
• Target and recruit additional providers to reduce member access grievances.
• Engage contracted providers in renegotiation of rates/language and assist with cost-control strategies.
• Advise team on negotiation of provider and routine ancillary contracts.
• Maintain relationships with significant providers and ensure network adequacy standards.
• Evaluate network and implement strategic plans to meet Molina standards.
• Assess contract language for regulatory compliance and coordinate with corporate counsel.
• Participate in fee schedule determinations and new reimbursement model input.
• Educate internal customers on contract terms and payment structures.
• Communicate terms clearly to physicians, hospitals, and ancillary providers.
• Participate in leadership and committees to support department goals.
• Lead or participate in contracting-related special projects and training for staff.
• Travel regionally to meet provider and network needs.

Skills

Contract negotiation

Relationship building

Data-driven decision making

Cross-functional collaboration

Verbal and written communication

Project management

MS Office proficiency

Tools

Contract management software

Job description

Molina Healthcare in Michigan seeks a senior leader to manage health plan provider network contracting. You will negotiate complex agreements, including value-based models, with physician groups, hospitals and ancillary providers across Medicaid/Medicare lines.

The role requires deep regulatory acumen, strong negotiation and relationship-building skills, and the ability to drive network adequacy and financial performance while working across a matrixed organization. Travel will be regional.