Remote and must live in NY or the Tristate area
JOB DESCRIPTION
Job Summary
Provides subject matter expertise and leadership for health plan provider
network complex contracting activities. Supports network strategy and
development with respect to adequacy, financial performance and operational
performance. Responsible for negotiating agreements, including value-based
payment methodology, with complex provider groups that are strategically
critical to plan success, including but not limited to: hospitals, independent
physician associations (IPAs), and behavioral health organizations.
Essential Job Duties
• Negotiates contracts and letters of agreement with the complex provider
community to secure high quality, cost-effective and marketable plan providers.
• Contracts/re-contracts with large-scale entities involving custom
reimbursement; executes standardized alternative payment model (APM) contracts;
issues escalations, and supports network adequacy, joint operating committees
(JOCs), and delegation oversight.
• Execution, management, and optimization of value-based contracts and enhanced
provider relationship management.
• Directs analysis of financial impact of deal terms and prepare details and
justification for executive approval for agreements outside of Molina approval
guidelines.
• In conjunction with contracting leadership, negotiates complex provider
contracts including high-priority physician group and facility contracts using
preferred, acceptable, discouraged, unacceptable (PADU) guidelines (emphasis on
number or percentage of membership in value-based relationship contracts).
• Develops and maintains provider contracts in contract management software.
• Targets and recruits additional providers to reduce member access grievances.
• Engages targeted contracted providers in renegotiation of rates and/or
language; assists with cost-control strategies that positively impact the
medical cost ratio (MCR) within each region.
• Advises network contracting team members on negotiation of individual provider
and routine ancillary contracts.
• Maintains contractual relationships with significant/highly visible providers.
• 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 corporate
attorney.
• Participates in fee schedule determinations including development of new
reimbursement models; seeks input on new reimbursement models from corporate
network leadership, legal and senior level engagement as required.
• Educates internal customers on provider contracts.
• Clearly and professionally communicates contract terms, payment structures,
and reimbursement rates to physician, hospital and ancillary providers.
• Participates with the leadership team and other committees to address the
strategic goals of the department and organization.
• Participates in contracting-related special projects as directed.
• Provides training, mentoring and support to new and existing contracting team
members.
• Travels regularly throughout designated regions to meet targeted needs.
Required Qualifications
• At least 5 years of experience in network contracting with large specialty or
multispecialty provider groups, and at least 3 years experience in provider
contract negotiations in a managed health care setting ideally negotiating
different provider contract types (i.e. physician/group/hospital), or equivalent
combination of relevant education and experience.
• Working familiarity with various managed health care provider compensation
methodologies, primarily across Medicaid and Medicare lines of business,
including but not limited to: value-based payment (VBP), fee-for service (FFS),
capitation and various forms of risk, etc.
• Negotiation and relationship building capabilities.
• Ability to navigate complex regulatory environments.
• Data-driven decision-making skills, and analytical abilities.
• Organizational skills and attention to detail.
• Ability to work cross-functionally with internal/external stakeholders in a
highly matrixed organization.
• Ability to manage multiple tasks and deadlines effectively.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
• Contracting experience with integrated delivery systems, hospitals and groups
(specialty and ancillary).
• Experience with Medicaid, Medicare, and Marketplace government-sponsored
programs.
To all current Molina employees: If you are interested in applying for this
position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina
Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V