Manager, Provider Contracts (Nationwide) Job in Irving 75014, Texas Us

MANAGER, PROVIDER CONTRACTS (NATIONWIDE)

 

About Molina Healthcare, Inc.

 

Molina Healthcare Inc., is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare-including individuals covered under Medicaid, and Medicare, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs. Currently we provide healthcare assistance to approximately 1.4 million members in sixteen (16) states. Molina has health plans in California, Indiana, Michigan, New Mexico, Ohio, Texas, Utah, Washington, Florida, Louisiana, Idaho, Maine, New Jersey, West Virginia, Virginia, Wisconsin and as well as 19 primary care clinics located in Northern and Southern California. The company's corporate headquarters are in Long Beach, California.

 

Molina Healthcare is a publicly traded Fortune 1000 company with approximately 4,200 employees and revenues of $3.6 billion.

 

POSITION SUMMARY

Plan, organize, staff, and assist in the supervision of the activities of the Provider Contracts unit within the MHI Provider Network Services Services Department.  Work with Director MHI Provider Network Strategy Services, Plan Provider Network Management Operations, senior management and Corporate stakeholders to develop and implement standardized provider contracts and contracting strategies. Manage provider networks to ensure adequacy, quality and access. Conduct high level negotiations/renegotiations with key providers and ensure outcomes fall within designated financial parameters. Resolve contract interpretation issues. Participate in internal/external meetings involving provider network activity.

This position will be based out of our Dallas, Texas office but is 60% travel.

 

JOB REQUIREMENTS 

·         Manage, train and assist the Contract Managers and Contract Specialist(s).  Interview, hire and complete performance appraisals.

·         In conjunction with the Director Provider Contracting, oversee 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 Molina membership.

·         Advise 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.

·         Achieve annual savings through recontracting initiatives.  Implement cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.

·         Utilize standardized contract templates and Pay for Performance strategies.

·         Develop and maintain Reimbursement Tolerance Parameters (across multiple specialties/ geographies).  Oversee the development of new reimbursement models in concert with Director and Senior leadership. Communicate new strategies to Corporate and applicable stakeholders for input. Utilize Standardized system (Emptoris) to track Contract Negotiation activity on an ongoing basis throughout the year.

·         Participate on the management team and other committees addressing the strategic goals of the department and organization.

·         Oversee the maintenance of all Provider Contract Templates.  Work with Legal and Corporate and applicable stakeholders on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.

 

REQUIRED EDUCATION: 

Bachelor’s degree in a related field (Business Administration, etc.,) or equivalent combination of education and experience required.

 

PREFERRED EDUCATION:

Master’s degree preferred   

 

REQUIRED EXPERIENCE: 
Minimum of 5 years in managed care with contract negotiations experience; 3 years of supervisory experience.

PREFERRED EXPERIENCE:
5+ years of experience in Managed Care contracting negotiations for all provider types-physician, hospital and ancillary providers. Minimum of 3 years experience in hospital and ancillary provider contracting.

Additional Skills and Knowledge:        

·         Excellent verbal and written communication skills with ability to prepare and execute group presentations.

·         Demonstrated knowledge of reimbursement methodologies and managed care processes; specific knowledge of contract negotiation skills. Specific knowledge of managed care lines of business, including Medicaid, Managed Medicaid, Medicare and Commercial HMO products.

·         Ability to work independently.

·         Demonstrated competency in Microsoft Office (MS Word, Excel, PowerPoint).

·         Ability to abide by Molina’s policies

·         Ability to maintain attendance to support required quality and quantity of work

·         Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

·         Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

·         Excellent influencing and negotiating skills.

·         Leads or supports department/team projects and initiatives.  Completes tasks as assigned

 

 

Molina Healthcare is an Equal Opportunity Employer.(EOE). M/F/V/D