Provider Contracts Manager (Value-Based)

Remote Job Description

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

Pay Range : $66,456 - $129,590 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.