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Provider Contracts Manager Jobs

Company

Molina Healthcare
Address United States
Employment type FULL_TIME
Salary
Category Hospitals and Health Care
Expires 2023-06-17
Posted at 11 months ago
Job Description

  • Remote and must live in New York***

Job Summary
Negotiates agreements with highly visible providers who are strategic to the success of the Plan, including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.
Knowledge/Skills/Abilities
  • Develops and maintains provider contracts in APTTUS contract management software.
  • Evaluates provider network and implement strategic plans with the goal of meeting Molina's network adequacy standards.
  • Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.
  • Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal.
  • Participates on the management team and other committees addressing the strategic goals of the department and organization.
  • Engages targeted contracted providers in renegotiation of rates and/or language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.
  • Educates internal customers on provider contracts.
  • Maintains contractual relationships with significant/highly visible providers.
  • Targets and recruits additional providers to reduce member access grievances.
  • In conjunction with Director/Manager Provider Contracts, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
  • Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
Job Qualifications
Required Education
Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience.
Required Experience
5-7 years
Preferred Education
Graduate degree
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: $66,456.22 - $129,589.63 a year*
  • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level