Provider Contracts Management Specialist

Job Summary As a crucial member of the Molina Health Plan team, the Provider Contracts Management Specialist is responsible for shaping and overseeing network strategies that drive quality, efficiency, and financial performance. This role aligns with Molina Healthcare's core mission and values while ensuring compliance with all relevant regulations. You will play a key role in negotiating agreements with various provider types, including hospitals and physician groups, to contribute to the success of our healthcare plans. Key Responsibilities Negotiate comprehensive contracts with healthcare providers to establish high-quality, cost-effective, and marketable networks, which may include alternative payment models. Oversee escalations, conduct network adequacy assessments, and manage relationships through joint operating committees and delegation oversight. Engage in high-priority contract negotiations, emphasizing value-based relationships with physician groups and facilities, adhering to PADU guidelines. Utilize contract management software to maintain and enhance provider contracts. Recruit new providers to expand member access and minimize grievances. Lead rate renegotiations and update contract language with existing providers to support cost control and improve Medical Care Ratios. Guide network provider contract specialists while nurturing important provider relationships. Ensure compliance with standards and regulations by assessing provider network adequacy. Contribute to the development of fee schedules and reimbursement models, working closely with corporate and legal teams. Educate internal teams about contract terms and maintain effective communication with providers. Engage in strategic planning and special projects, with occasional regional travel as needed. Qualifications Required Education:

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

5-7 years in healthcare contract management, including at least 3 years in provider negotiations within managed care, along with knowledge of Medicaid and Medicare payment models. Preferred Education:

Master's Degree or equivalent experience. Preferred Experience:

Over 3 years in provider network contracting. Molina offers competitive benefits and is proud to be an Equal Opportunity Employer.