Director, Provider Contracts (Must reside in Georgia)

Molina Health Plan Provider Network Contracting

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, staffs, and coordinates the Provider Contracts activities for the state health plan. Works with direct management, senior leadership / management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.

Job Duties

• Manages the Plan's Provider Contracting functions and team members.
• Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.
• In conjunction with direct management and senior leadership, oversees development of provider contracting strategies including VBP.
• Leads the achievement of annual savings through recontracting initiatives.
• Leads the preparation and negotiations of provider contracts and oversee negotiation of contracts, including VBP, in concert with established company guidelines with physicians, hospitals, and other health care providers.
• Utilizes standardized contract templates and VBP / Pay for Performance strategies.
• Develops and maintains Reimbursement Tolerance Parameters (across multiple specialties / geographies).
• Communicates new strategies to corporate provider network leadership for input.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.
• Oversees the maintenance of all Provider Contract templates including VBP program templates.
• Manages the contracting relationships with area agencies and community partners to support and advance Plan initiatives.
• Develops and implements contracting strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.
• Manages and provides coaching to Network Contracting Staff.

Job Qualifications

Required Education : Bachelors Degree in a related field or equivalent experience.

Required Experience / Knowledge, Skills & Abilities :

Preferred Education : Masters Degree in a related field or an equivalent combination of education and experience

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $97,299 - $227,679 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.