Molina Healthcare
Provider Contracts Manager (Health Systems)
Molina Healthcare, Lansing, Michigan, United States
Provider Contracts Manager (Health Systems)
Join to apply for the
Provider Contracts Manager (Health Systems)
role at
Molina Healthcare
1 day ago - Be among the first 25 applicants
Work Location:
Remote; must live in Michigan.
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.
Job Duties
Negotiate contracts with complex providers who are strategic to the success of the plan, including but not limited to hospitals, independent physician associations, and complex behavioral health arrangements.
Contract/re‑contract with large scale entities involving custom reimbursement. Execute standardized alternative payment method contracts.
Handle escalations, network adequacy, joint operating committees, and delegation oversight. Ensure tighter knit proximity after contract.
In conjunction with Director/Manager, Provider Contracts, negotiate complex provider contracts including high priority physician group and facility contracts using PADU guidelines. Emphasis on number or percentage of membership in value based relationship contracts.
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. Assist with cost control strategies that positively impact 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 with the goal of meeting Molina’s network adequacy standards.
Assess contract language for compliance with corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
Participate in fee schedule determinations including development of new reimbursement models. Seek input on new reimbursement models from corporate network management, legal, and VP level engagement as required.
Educate internal customers on provider contracts.
Communicate contract terms, payment structures, and reimbursement rates to physicians, hospitals, and ancillary providers professionally.
Participate with the management team and other committees addressing the strategic goals of the department and organization.
Participate in other contracting related special projects as directed.
Travel regularly throughout designated regions to meet targeted needs.
Job Qualifications Required Education:
Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.
Required Experience / Knowledge, Skills & Abilities:
5-7 years contract-related experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care environment.
3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee‑for‑service, capitation and various forms of risk, ASO, etc.
Preferred Education:
Master’s Degree in a related field or an equivalent combination of education and experience.
Preferred Experience:
3+ years in Provider Network contracting.
Seniority Level
Mid‑Senior level
Employment Type
Full‑time
Job Function
Management and Manufacturing
Hospitals and Health Care
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range:
$66,456 - $129,590 / ANNUAL
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#J-18808-Ljbffr
Provider Contracts Manager (Health Systems)
role at
Molina Healthcare
1 day ago - Be among the first 25 applicants
Work Location:
Remote; must live in Michigan.
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.
Job Duties
Negotiate contracts with complex providers who are strategic to the success of the plan, including but not limited to hospitals, independent physician associations, and complex behavioral health arrangements.
Contract/re‑contract with large scale entities involving custom reimbursement. Execute standardized alternative payment method contracts.
Handle escalations, network adequacy, joint operating committees, and delegation oversight. Ensure tighter knit proximity after contract.
In conjunction with Director/Manager, Provider Contracts, negotiate complex provider contracts including high priority physician group and facility contracts using PADU guidelines. Emphasis on number or percentage of membership in value based relationship contracts.
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. Assist with cost control strategies that positively impact 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 with the goal of meeting Molina’s network adequacy standards.
Assess contract language for compliance with corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
Participate in fee schedule determinations including development of new reimbursement models. Seek input on new reimbursement models from corporate network management, legal, and VP level engagement as required.
Educate internal customers on provider contracts.
Communicate contract terms, payment structures, and reimbursement rates to physicians, hospitals, and ancillary providers professionally.
Participate with the management team and other committees addressing the strategic goals of the department and organization.
Participate in other contracting related special projects as directed.
Travel regularly throughout designated regions to meet targeted needs.
Job Qualifications Required Education:
Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.
Required Experience / Knowledge, Skills & Abilities:
5-7 years contract-related experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care environment.
3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee‑for‑service, capitation and various forms of risk, ASO, etc.
Preferred Education:
Master’s Degree in a related field or an equivalent combination of education and experience.
Preferred Experience:
3+ years in Provider Network contracting.
Seniority Level
Mid‑Senior level
Employment Type
Full‑time
Job Function
Management and Manufacturing
Hospitals and Health Care
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range:
$66,456 - $129,590 / ANNUAL
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#J-18808-Ljbffr