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Provider Contracting Manager

2 months ago

Albuquerque, New Mexico, United States Molina Healthcare Full time
Job Description

**Job Summary**

Molina Healthcare's Provider Network Contracting team is responsible for developing and maintaining strategic relationships with healthcare providers to ensure high-quality, cost-effective care for our members. As a Provider Contracting Manager, you will play a critical role in negotiating contracts with complex providers, including hospitals, independent physician associations, and behavioral health organizations.

**Key Responsibilities**

  • Negotiate contracts with complex providers to ensure alignment with Molina's network strategy and compliance with regulatory requirements.
  • Develop and maintain provider contracts in contract management software.
  • Target and recruit additional providers to reduce member access grievances.
  • Engage contracted providers in renegotiation of rates and/or language to positively impact the Medical Care Ratio (MCR) within each region.
  • Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
  • Maintain contractual relationships with significant/highly visible providers.
  • Evaluate provider network and implement strategic plans to meet Molina's network adequacy standards.
  • Assess contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
  • Participate in fee schedule determinations, including development of new reimbursement models.
  • Clearly and professionally communicate contract terms, payment structures, and reimbursement rates to physician, hospital, and ancillary providers.
  • Participate with the management team and other committees addressing the strategic goals of the department and organization.

**Requirements**

  • Bachelor's Degree in a healthcare-related field or an equivalent combination of education and experience.
  • 5-7 years of contract-related experience in the healthcare field, including provider offices, managed care organizations, or other healthcare environments.
  • 3+ years of experience in provider contract negotiations in a managed healthcare setting, ideally in negotiating different provider contract types.
  • Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business.