Manager, Provider Contracts (Remote in MS only)

$65,792 - $142,549/Yr

Molina Healthcare - Gulfport, MS

Full-time - Manager

Remote - Gulfport, MS

Insurance Carriers and Related Activities

About the position

The Manager, Provider Contracts at Molina Healthcare is responsible for overseeing the network strategy and development related to provider contracting, ensuring compliance with regulations, and maintaining network adequacy. This role involves heavy negotiations and managing complex contracts, particularly those involving Alternative Payment Methods. The position requires collaboration with various operational departments and focuses on achieving cost-effective and high-quality provider networks.

Responsibilities

• Manage the Plan's Provider Contracting functions and team members.
• Negotiate contracts with the Complex Provider Community to ensure high quality and cost-effective providers.
• Develop health plan-specific provider contracting strategies, including Value Based Payment (VBP).
• Assist in achieving annual savings through recontracting initiatives.
• Prepare provider contracts in accordance with company guidelines.
• Oversee the development of new reimbursement models in collaboration with the Director.
• Ensure compliance with provider panel and network capacity requirements.
• Develop strategies to minimize the company's financial exposure.
• Advise Network Provider Contract Specialists on contract negotiations.
• Evaluate provider network and implement strategic plans to meet network adequacy standards.
• Participate in fee schedule determinations and development of new reimbursement models.
• Educate internal customers on provider contracts.
• Manage and coach Network Contracts Staff.

Requirements

• Bachelor's Degree in a related field or equivalent experience.
• 5-7 years experience in Healthcare Administration, Managed Care, Provider Contracting, or Provider Services, including 2+ years in a leadership position.
• 3+ years experience in provider contract negotiations in a managed healthcare setting.
• Working experience with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare.
• Minimum 2 years experience managing/supervising employees.

Nice-to-haves

• Master's Degree in a related field or equivalent combination of education and experience.
• Experience negotiating Alternative Payment Methods.

Benefits

• Competitive benefits and compensation package.