Negotiates national agreements with highly visible providers including integrated delivery systems, hospitals, and physician groups that result in high quality, cost effective, and marketable providers.
In conjunction with Director/Manager Provider Contracts, negotiates 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 implements strategic plans with the goal of meeting Molina's network adequacy standards.
Assesses contract language for compliance with corporate standards and regulatory requirements and reviews 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.
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.
Molina Healthcare offers a competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $155,508 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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