Manager, Hospital Health Plan Provider Contracts (...

JOB DESCRIPTION Employee for this role must reside in Florida Job Summary Leads and manages team responsible for Hospital Health Plan provider network contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Responsible for negotiating complex contracts that are strategically critical to plan success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements. Essential Job Duties u2022 Oversees the planu2019s Hospital provider contracting function; collaborates with other operational departments and functional business unit stakeholders on various provider contracting activities. u2022 Negotiates contracts with the complex provider community that result in high quality, cost-effective and marketable providers. u2022 Contracts/re-contracts with large-scale entities involving custom reimbursement. u2022 Executes standardized alternative payment model (APM) or value-based payment (VBP) contracts. u2022 Issues escalations and supports network adequacy, joint operating committees (JOCs), and delegation oversight. u2022 In conjunction with contracting leadership, develops health plan-specific provider contracting strategies including VBP; includes identifying specialties and geographic locations to concentrate resources for the purpose of establishing a sufficient network of participating providers to serve the health care needs of the plan's members, in addition to identifying VBP provider targets to meet Molina goals. u2022 Assists in achieving annual savings through recontracting initiatives; implements cost-control initiatives to positively influence the medical cost ratio (MCR) in each contracted region. u2022 Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, managed long-term services and supports (MLTSS) and other health care providers. u2022 Utilizes established reimbursement tolerance parameters (across multiple specialties/ geographies), and oversees the development of new reimbursement models. u2022 Oversees the maintenance of all provider and payer contract templates; collaborates with legal and corporate network management on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. u2022 Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines; produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements. u2022 Develops and implements strategies to minimize the companyu2019s financial exposure; monitors and adjusts strategy implementation as needed to achieve desire goals and reduce minimize the companyu2019s financial exposure. u2022 Advises network provider contract specialists on negotiation of individual provider and routine ancillary contracts. 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 management, legal and senior level engagement as required. u2022 Educates internal customers on provider contracts. u2022 Participates on the management team and other committees addressing the strategic goals of the department and organization. u2022 Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. Required Qualifications u2022 At least 7 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 4 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 At least 1 year of management/leadership experience. u2022 Experience 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 Strong negotiation and relationship building capabilities. u2022 Ability to navigate complex regulatory environments. u2022 Strong organizational skills and attention to detail. u2022 Data-driven decision-making skills, and analytical abilities. u2022 Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization. u2022 Strong ability to manage multiple tasks and deadlines effectively. u2022 Strong verbal and written communication skills. u2022 Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications u2022 Strong hospital conracting experience u2022 Experience negotiating alternative payment models (APMs). u2022 Experience with Medicaid, Medicare, and Marketplace government-sponsored programs. #PJHPO #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: $80,412 - $156,803 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-03-09