AlbuquerqueRecruiter Since 2001
the smart solution for Albuquerque jobs

Dir, Provider Contracts - NM Residents Preferred

Company: Molina Healthcare
Location: Albuquerque
Posted on: August 5, 2022

Job Description:

Dir, Provider Contracts - NM Residents Preferred Molina Healthcare United States Job ID 2013707 KNOWLEDGE/SKILLS/ABILITIESPlans, 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.

  • Monitors and reports network adequacy for Medicare and Medicaid services.
  • In conjunction with direct management and senior leadership, oversees development of provider contracting strategies, 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.
  • Advises in preparation and negotiations of provider contracts and oversee negotiation of contracts in concert with established company guidelines with physicians, hospitals, and other health care providers.
  • Utilizes standardized contract templates and 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. 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 relationship with area agencies and community provider partners to support and advance Plan initiatives.
  • Develops and implements strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.JOB QUALIFICATIONSRequired EducationBachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.Required Experience
    • 7+ years' experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services.
    • Min. 2 years' experience managing/supervising employees.Preferred EducationMaster's DegreePreferred Experience6+ years in Provider Network contractingTo 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.About UsMolina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Job Type: Full Time Posting Date: 05/12/2022 Sign up to receive automatic notices when jobs that match your interests are posted.

Keywords: Molina Healthcare, Albuquerque , Dir, Provider Contracts - NM Residents Preferred, Other , Albuquerque, New Mexico

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest New Mexico jobs by following @recnetNM on Twitter!

Albuquerque RSS job feeds