Director, Provider Contracts
Molina Healthcare
**KNOWLEDGE/SKILLS/ABILITIES**
Plans, organizes, staffs, and coordinates the Provider Contracts activities for contracts at a National Level. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.
+ Monitors and reports network adequacy for Medicare and Medicaid services.
+ In conjunction with direct management and senior leadership, oversees development of provider contracting strategies, 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.
+ Advises in preparation and negotiations of provider contracts and oversee negotiation of contracts in concert with established company guidelines with physicians, hospitals, and other health care providers.
+ Utilizes standardized contract templates and 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. 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 relationship with area agencies and community provider partners to support and advance Plan initiatives.
+ Develops and implements strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.
**Required Experience**
+ 7+ years’ experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services.
+ Min. 2 years’ experience managing/supervising employees.
**Preferred Education**
Master's Degree
**Preferred Experience**
6+ years in Provider Network contracting
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: $97,299 - $227,679 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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