Provider Contracts Manager HP - Core

Job Description Job Summary Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and JOCs on exception, including standardized fee for service and other core payment method contracts with predefined, common programs. Typically does not entail heavy negotiations. Minimal ongoing engagement after contract. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when applicable, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Job Duties This role negotiates assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. Contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and Joint Operating Committees on exception. u2022 Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments, including but not limited to Fee for Service and Basic Alternative Payment Methods including Pay for Performance. u2022 Assesses and negotiates contract language for ancillary providers including, but not limited to Behaviorial Health, Home Health, Hospice, Dialysis, Home and Community based providers. Ensure compliance with Corporate standards and regulatory requirements and review revised language with leadership based on feedback rom assigned MHI attorney. u2022 Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. u2022 Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts. u2022 Identified as contract system lead by developing and maintaining provider contracts in contract management software. u2022 Targets and recruits additional providers to reduce member access grievances. u2022 Supports network development throughout state to including researching, recruiting and negotiating with providers. u2022 Participates in the evaluation of provider network and implementation of strategic plans to meet Molinau2019s network adequacy standards. u2022 Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. u2022 Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided and other information needed to complete the contract profile. u2022 Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes. u2022 Assists Manager and/or Director in the completion of Block Transfer Filings u2022 Facilitates and resolves claim and configuration issues with impacted departments. u2022 Communicates proactively with other departments in order to ensure effective and efficient business results. u2022 Trains and monitors newly hired Contract Specialist(s). u2022 Participates with the management team and other committees addressing the strategic goals of the department and organization. u2022 Participates in other contracting related special projects as directed. u2022 Travels regularly throughout designated regions to meet targeted needs. Job Qualifications REQUIRED EDUCATION : Bacheloru2019s Degree or equivalent work experience in health care field including, but not limited to, provideru2019s office, managed care, or other health care field. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES : u2022 5-7 years previous experience in contracting with large specialty or multispecialty provider groups. u2022 3+ years experience in provider contract negotiations in a managed healthcare setting PREFERRED EXPERIENCE : Knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) contracts highly desirable. STATE SPECIFIC REQUIREMENTS : Certified Recovery Peer Specialist certification required in the state of Florida 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: $64,350 - $141,371 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-04