Provider Contracts Manager (Value-Based) at Molina Talent Acquisition

, , United States -

Full Time

Start Date

Immediate

Expiry Date

16 Jan, 26

Salary

0.0

Posted On

18 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Negotiation, Contract Management, Provider Recruitment, Cost Control, Compliance, Strategic Planning, Reimbursement Models, Education, Network Adequacy, Contract Language, Medical Care Ratio, Team Participation, Provider Relations, Healthcare Knowledge, Legal Review, Internal Customer Education

Industry

Hospitals and Health Care

Description

***Remote and must live in Michigan*** JOB DESCRIPTION Job Summary Negotiates value-based agreements with highly visible providers including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers. KNOWLEDGE/SKILLS/ABILITIES In conjunction with Director/Manager Provider Contracts, negotiates value-based high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines. Develops and maintains provider contracts in APTTUS contract management software. Targets and recruits additional providers to reduce member access grievances. 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. Maintains contractual relationships with significant/highly visible providers. Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts. Evaluates provider network and implement strategic plans with the goal of meeting Molina's network adequacy standards. Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney. Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal. Educates internal customers on provider contracts. Participates on the management team and other committees addressing the strategic goals of the department and organization. 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. #PJHPO #LI-AC1

Responsibilities

Negotiate value-based agreements with providers to ensure high quality and cost-effective services. Maintain contractual relationships and assist with cost control strategies impacting the Medical Care Ratio.