Molina Healthcare
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Provider Contracts Manager
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Molina Healthcare 2 days ago Be among the first 25 applicants Join to apply for the
Provider Contracts Manager
role at
Molina Healthcare Job Summary
Ensure all your application information is up to date and in order before applying for this opportunity.
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. Remote and must live in Washington***
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.
Responsible for contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and JOCs on exception, including standardized fee for service and other core payment method contracts with predefined, common programs.
Typically does not entail heavy negotiations. Minimal ongoing engagement after contract. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when applicable, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
Job Duties
This role negotiates assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. Contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and Joint Operating Committees on exception.
Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments, including but not limited to Fee for Service and Basic Alternative Payment Methods including Pay for Performance. Assesses and negotiates contract language for ancillary providers including, but not limited to Behaviorial Health, Home Health, Hospice, Dialysis, Home and Community based providers. Ensure compliance with Corporate standards and regulatory requirements and review revised language with leadership based on feedback rom assigned MHI attorney. Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts. Identified as contract system lead by developing and maintaining provider contracts in contract management software. Targets and recruits additional providers to reduce member access grievances. Supports network development throughout state to including researching, recruiting and negotiating with providers. Participates in the evaluation of provider network and implementation of strategic plans to meet Molina’s network adequacy standards. Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided and other information needed to complete the contract profile. Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes. Assists Manager and/or Director in the completion of Block Transfer Filings Facilitates and resolves claim and configuration issues with impacted departments. Communicates proactively with other departments in order to ensure effective and efficient business results. Trains and monitors newly hired Contract Specialist(s). Participates with the management team and other committees addressing the strategic goals of the department and organization. Participates in other contracting related special projects as directed. Travels regularly throughout designated regions to meet targeted needs.
Job Qualifications
REQUIRED EDUCATION :
Bachelor’s Degree or equivalent work experience in health care field including, but not limited to, provider’s office, managed care, or other health care field.
Required Experience/Knowledge, Skills & Abilities
5-7 years previous experience in contracting with large specialty or multispecialty provider groups. 3+ years experience in provider contract negotiations in a managed healthcare setting
Preferred Experience
Knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) contracts highly desirable.
State Specific Requirements
Certified Recovery Peer Specialist certification required in the state of Florida
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.
Pay Range: $77,969 - $135,480 / ANNUAL
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionManagement and Manufacturing IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Molina Healthcare by 2x Sign in to set job alerts for “Contract Manager” roles.Regulatory Affairs Manager, Diagnostics/IVDREMOTE Global Supply Manager (Custom Silicon) Seattle, WA $160,000.00-$210,000.00 5 days ago Project Manager – Budgeting and Planning SystemsDistribution Project Manager - Electrical UtilityAssociate Scientific Project and Alliance Manager - Neural Dynamics / Scientific Operations Seattle, WA $104,050.00-$128,700.00 1 week ago Software Asset Management Project Manager Tacoma, WA $95,000.00-$150,000.00 1 month ago Contract Compliance Specialist (Government Contract Accounting Compliance) Seattle, WA $157,000.00-$225,000.00 5 days ago Pacific, WA $91,000.00-$113,500.00 1 week ago Project Manager - Mobile Core Networks (4G/5G) Redmond, WA $90,000.00-$120,000.00 3 weeks ago Freight Rail Client Team Leader / Senior Project Manager, Transit and Rail - Tacoma, WA Tacoma, WA $130,000.00-$210,000.00 2 weeks ago Seattle, WA $90,000.00-$100,000.00 1 week ago Redmond, WA $65,000.00-$95,000.00 1 month ago Redmond, WA $126,000.00-$165,000.00 1 day ago Seattle, WA $140,000.00-$175,000.00 1 week ago Organizational Change Management Project Manager Redmond, WA $126,000.00-$154,000.00 1 week ago Project Manager - Customer Story Content Redmond, WA $87,000.00-$112,500.00 5 days ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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Provider Contracts Manager
role at
Molina Healthcare 2 days ago Be among the first 25 applicants Join to apply for the
Provider Contracts Manager
role at
Molina Healthcare Job Summary
Ensure all your application information is up to date and in order before applying for this opportunity.
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. Remote and must live in Washington***
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.
Responsible for contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and JOCs on exception, including standardized fee for service and other core payment method contracts with predefined, common programs.
Typically does not entail heavy negotiations. Minimal ongoing engagement after contract. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when applicable, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
Job Duties
This role negotiates assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. Contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and Joint Operating Committees on exception.
Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments, including but not limited to Fee for Service and Basic Alternative Payment Methods including Pay for Performance. Assesses and negotiates contract language for ancillary providers including, but not limited to Behaviorial Health, Home Health, Hospice, Dialysis, Home and Community based providers. Ensure compliance with Corporate standards and regulatory requirements and review revised language with leadership based on feedback rom assigned MHI attorney. Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts. Identified as contract system lead by developing and maintaining provider contracts in contract management software. Targets and recruits additional providers to reduce member access grievances. Supports network development throughout state to including researching, recruiting and negotiating with providers. Participates in the evaluation of provider network and implementation of strategic plans to meet Molina’s network adequacy standards. Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided and other information needed to complete the contract profile. Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes. Assists Manager and/or Director in the completion of Block Transfer Filings Facilitates and resolves claim and configuration issues with impacted departments. Communicates proactively with other departments in order to ensure effective and efficient business results. Trains and monitors newly hired Contract Specialist(s). Participates with the management team and other committees addressing the strategic goals of the department and organization. Participates in other contracting related special projects as directed. Travels regularly throughout designated regions to meet targeted needs.
Job Qualifications
REQUIRED EDUCATION :
Bachelor’s Degree or equivalent work experience in health care field including, but not limited to, provider’s office, managed care, or other health care field.
Required Experience/Knowledge, Skills & Abilities
5-7 years previous experience in contracting with large specialty or multispecialty provider groups. 3+ years experience in provider contract negotiations in a managed healthcare setting
Preferred Experience
Knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) contracts highly desirable.
State Specific Requirements
Certified Recovery Peer Specialist certification required in the state of Florida
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.
Pay Range: $77,969 - $135,480 / ANNUAL
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionManagement and Manufacturing IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Molina Healthcare by 2x Sign in to set job alerts for “Contract Manager” roles.Regulatory Affairs Manager, Diagnostics/IVDREMOTE Global Supply Manager (Custom Silicon) Seattle, WA $160,000.00-$210,000.00 5 days ago Project Manager – Budgeting and Planning SystemsDistribution Project Manager - Electrical UtilityAssociate Scientific Project and Alliance Manager - Neural Dynamics / Scientific Operations Seattle, WA $104,050.00-$128,700.00 1 week ago Software Asset Management Project Manager Tacoma, WA $95,000.00-$150,000.00 1 month ago Contract Compliance Specialist (Government Contract Accounting Compliance) Seattle, WA $157,000.00-$225,000.00 5 days ago Pacific, WA $91,000.00-$113,500.00 1 week ago Project Manager - Mobile Core Networks (4G/5G) Redmond, WA $90,000.00-$120,000.00 3 weeks ago Freight Rail Client Team Leader / Senior Project Manager, Transit and Rail - Tacoma, WA Tacoma, WA $130,000.00-$210,000.00 2 weeks ago Seattle, WA $90,000.00-$100,000.00 1 week ago Redmond, WA $65,000.00-$95,000.00 1 month ago Redmond, WA $126,000.00-$165,000.00 1 day ago Seattle, WA $140,000.00-$175,000.00 1 week ago Organizational Change Management Project Manager Redmond, WA $126,000.00-$154,000.00 1 week ago Project Manager - Customer Story Content Redmond, WA $87,000.00-$112,500.00 5 days ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr