Health Plan Provider Contracts Manager - Complex (FL ...

JOB DESCRIPTION Employee for this role must reside in the state of Florida 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 u2022 Negotiates contracts and letters of agreement with the complex provider community to secure high quality, cost-effective and marketable plan providers. u2022 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. u2022 Execution, management, and optimization of value-based contracts and enhanced provider relationship management. u2022 Directs analysis of financial impact of deal terms and prepare details and justification for executive approval for agreements outside of Molina approval guidelines. u2022 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). 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 cost ratio (MCR) within each region. u2022 Advises network contracting team members 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 corporate attorney. u2022 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. 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 leadership team and other committees to address the strategic goals of the department and organization. u2022 Participates in contracting-related special projects as directed. u2022 Provides training, mentoring and support to new and existing contracting team members. u2022 Up to 30% travel throughout designated regions to meet targeted needs. Required Qualifications u2022 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. u2022 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. u2022 Negotiation and relationship building capabilities. u2022 Ability to navigate complex regulatory environments. u2022 Data-driven decision-making skills, and analytical abilities. u2022 Organizational skills and attention to detail. u2022 Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization. u2022 Ability to manage multiple tasks and deadlines effectively. u2022 Effective verbal and written communication skills. u2022 Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications u2022 Contracting experience with integrated delivery systems, hospitals and groups (specialty and ancillary). u2022 Experience with Medicaid, Medicare, and Marketplace government-sponsored programs. #PJCorp #LI-AC1 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 Pay Range: $73,102 - $142,549 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-01-19