Job Summary
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. Responsible for leading the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Contracting functions. This role primarily leads negotiations of contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract/Re-contracting with large scale entities involving custom reimbursement. Executes standardized Alternative Payment Method or Value Based Payment (VBP) contracts. Lead initiatives and activities issue escalations, network adequacy, and Joint Operating Committees.
• 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. This includes identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of members and patients in addition to identifying VBP provider targets to meet Molina goals.
• Leads the achievement of annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
• Leads 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). Oversees the development of new reimbursement models in concert with direct management and senior leadership/management.
• Communicates new strategies to corporate provider network leadership for input.
• Utilize standardized system(s) to track contract negotiation activity on an ongoing basis throughout the year.
• 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. Works with Legal and Corporate Network Management as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• 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.
• Manages and evaluates team member performance; provides coaching, consultation, employee development, and recognition; ensures ongoing, appropriate staff training; holds regular team meetings to drive good communication and collaboration; and has responsibility for the selection, orientation and mentoring of new staff.
Job Qualifications
REQUIRED EDUCATION:
Bachelor’s Degree in a related field (Business Administration, etc.) or equivalent experience.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 7+ years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position
• 5+ years experience in provider contract negotiations in a managed healthcare setting including in negotiating different provider contract types and VBP models, i.e. physician, group and hospital contracting, etc.
• Working experience with, and strong knowledge of, various managed healthcare provider compensation and VBP methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc.
• Min. 2 years experience managing/supervising employees.
PREFERRED EDUCATION:
Master's Degree in a related field or an equivalent combination of education and experience
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.
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