Provider Contracts Manager - Complex (Remote in ID)

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. Negotiates agreements with Complex providers who are strategic to the success of the Plan, including but not limited to, Hospitals, Independent Physician Association, and complex Behavioral Health arrangements. Job Duties This role negotiates contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract/Re-contracting with large scale entities involving custom reimbursement. Executes standardized Alternative Payment Method contracts. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight. Tighter knit proximity ongoing after contract. u2022 In conjunction with Director/Manager, Provider Contracts, negotiates Complex Provider contracts including but not limited to 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. u2022 Develops and maintains provider contracts in contract management software. u2022 Targets and recruits additional providers to reduce member access grievances. u2022 Engages targeted contracted providers in renegotiation of rates and/or language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region. u2022 Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts. u2022 Maintains contractual relationships with significant/highly visible providers. u2022 Evaluates provider network and implement strategic plans with the goal of meeting Molinau2019s network adequacy standards. u2022 Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney. u2022 Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management, legal and VP level engagement as required. u2022 Educates internal customers on provider contracts. u2022 Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. 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 Rarely travels within the state. Job Qualifications REQUIRED EDUCATION : Bacheloru2019s Degree in a healthcare related field or an equivalent combination of education and experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES : u2022 5-7 years contract-related experience in the health care field including, but not limited to, provideru2019s office, managed care organization, or other health care environment. u2022 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, group and hospital contracting, etc. u2022 Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee-for service, capitation and various forms of risk, ASO, etc. PREFERRED EDUCATION : Master's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE : 3+ 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. #PJCorp #LI-AC1 Pay Range: $66,456 - $129,590 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-12-05