KNOWLEDGE/SKILLS/ABILITIES

Plans, organizes, staffs, and coordinates the Provider Contracts activities for contracts at a National Level. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.

Monitors and reports network adequacy for Medicare and Medicaid services. In conjunction with direct management and senior leadership, oversees development of provider contracting strategies, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of members and patients. Advises in preparation and negotiations of provider contracts and oversee negotiation of contracts in concert with established company guidelines with physicians, hospitals, and other health care providers. Utilizes standardized contract templates and Pay for Performance strategies. Develops and maintains Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with direct management and senior leadership/management. Communicates new strategies to corporate provider network leadership for input. Utilize standardized system(s) to track contract negotiation activity on an ongoing basis throughout the year. Participates on the management team and other committees addressing the strategic goals of the department and organization. Oversees the maintenance of all Provider Contract templates. Works with Legal and Corporate Network Management as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Manages the relationship with area agencies and community provider partners to support and advance Plan initiatives. Develops and implements strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.

Required Experience

7+ years’ experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services. Min. 2 years’ experience managing/supervising employees.

Preferred Education

Master's Degree

Preferred Experience

6+ years in Provider Network contracting

 

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.