Molina Healthcare
Provider Contracts Manager (Must reside in Georgia)
Molina Healthcare, Georgia Center, Vermont, United States
Overview
Provider Contracts Manager (Must reside in Georgia) 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. Responsibilit ies
Negotiate contracts with Complex Provider Community to support Plan success, including Hospitals, Independent Physician Associations, and complex Behavioral Health arrangements. 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 and assist with cost control strategies impacting 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; review revised language with assigned MHI attorney. Participate in fee schedule determinations and development of new reimbursement models; seek input from Corporate Network Management, legal and VP level as required. Educate internal customers on provider contracts; clearly communicate contract terms, payment structures, and reimbursement rates to physicians, hospitals, and ancillary providers. Participate with management team and other committees addressing strategic goals; participate in other contracting-related special projects as directed. Travel regularly throughout designated regions to meet targeted needs. Qualifications
REQUIRED EDUCATION: Bachelor’s Degree in a healthcare-related field or equivalent combination of education and experience. 5-7 years contract-related experience in the healthcare field (provider’s office, managed care organization, or similar). 3+ years experience in provider contract negotiations in a managed healthcare setting (physician, group, and hospital contracts). Working familiarity with managed care provider compensation methodologies across Medicaid and Medicare, including Value Based Payment, fee-for-service, capitation and various risk arrangements (ASO, etc.). Preferred
Master’s Degree in a related field or equivalent combination of education and experience. 3+ years in Provider Network contracting. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Actual compensation may vary by location, experience, and skill. Employment details
Employment type: Full-time Seniority level: Mid-Senior level Industry: Hospitals and Health Care
#J-18808-Ljbffr
Provider Contracts Manager (Must reside in Georgia) 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. Responsibilit ies
Negotiate contracts with Complex Provider Community to support Plan success, including Hospitals, Independent Physician Associations, and complex Behavioral Health arrangements. 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 and assist with cost control strategies impacting 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; review revised language with assigned MHI attorney. Participate in fee schedule determinations and development of new reimbursement models; seek input from Corporate Network Management, legal and VP level as required. Educate internal customers on provider contracts; clearly communicate contract terms, payment structures, and reimbursement rates to physicians, hospitals, and ancillary providers. Participate with management team and other committees addressing strategic goals; participate in other contracting-related special projects as directed. Travel regularly throughout designated regions to meet targeted needs. Qualifications
REQUIRED EDUCATION: Bachelor’s Degree in a healthcare-related field or equivalent combination of education and experience. 5-7 years contract-related experience in the healthcare field (provider’s office, managed care organization, or similar). 3+ years experience in provider contract negotiations in a managed healthcare setting (physician, group, and hospital contracts). Working familiarity with managed care provider compensation methodologies across Medicaid and Medicare, including Value Based Payment, fee-for-service, capitation and various risk arrangements (ASO, etc.). Preferred
Master’s Degree in a related field or equivalent combination of education and experience. 3+ years in Provider Network contracting. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Actual compensation may vary by location, experience, and skill. Employment details
Employment type: Full-time Seniority level: Mid-Senior level Industry: Hospitals and Health Care
#J-18808-Ljbffr