• Provider Contracts Manager

    Molina Healthcare (Warren, MI)


    _***Remote and must live in Michigan***_

    JOB DESCRIPTION

    Job Summary

    Negotiates 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 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

    Pay Range: $66,456 - $129,590 / ANNUAL

    *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.