Job Details

Provider Contracts Manager HP - Complex (Remote in ID) at Molina Healthcare in Twin Falls, Idaho, United States 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 Healthcares overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Negotiates agreements with Complex providers who are strategic to the success of the Plan, including but not limited to, Hospitals, Independent Physician Association, and complex Behavioral Health arrangements. Job Duties This role negotiates 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 contracts. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight. Tighter knit proximity ongoing after contract. - In conjunction with Director/Manager, Provider Contracts, negotiates Complex Provider contracts including but not limited to high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines. Emphasis on number or percentage of Membership in Value Based Relationship Contracts. - Develops and maintains provider contracts in 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. - Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts. - Maintains contractual relationships with significant/highly visible providers. - Evaluates provider network and implement strategic plans with the goal of meeting Molinas network adequacy standards. - Assesses contract language for compliance with Corporate standards and regulatory requirements and review 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, legal and VP level engagement as required. - Educates internal customers on provider contracts. - Clearly and professio To view full details and how to apply, please login or create a Job Seeker account