Racine, WI, 53408, USA
4 days ago
Director, Provider Contracts
**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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