Dir, Provider Contracts HP
Company: Molina Healthcare
Location: Albuquerque
Posted on: May 7, 2024
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Job Description:
Job Description
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.
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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.
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--- 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.
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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
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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. Pay Range: $87,568.7 - $189,732.18 / ANNUAL
*Actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level.
Keywords: Molina Healthcare, Albuquerque , Dir, Provider Contracts HP, Other , Albuquerque, New Mexico
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