Remote and must live in the United States
JOB DESCRIPTION
Job Summary
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.
KNOWLEDGE/SKILLS/ABILITIES
- In conjunction with Contract Directors and Molina leadership, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
- Targets and recruits additional providers to meet business objectives.
- 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.
- Managers complex contracts for multiple states
- Evaluates provider network and implement strategic plans with the goal of meeting Molina's 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 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.
JOB QUALIFICATIONS
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
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: $77,969 - $155,508 / ANNUAL
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.