Provider Contracts Manager

Company: Molina Healthcare
Location: Caledonia
Posted on: April 7, 2025

Job Description:

***Remote and must live in the United States***JOB DESCRIPTIONJob SummaryNegotiates National agreements with highly visible providers including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.KNOWLEDGE/SKILLS/ABILITIES

• In conjunction with Contract Directors and Molina leadership, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
• Targets and recruits additional providers to meet business objectives.
• 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.
• Maintains contractual relationships with significant/highly visible providers.
• Managers complex contracts for multiple states..
• 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 MHI attorney.
• Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal.
• Educates internal customers on provider contracts.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.JOB QUALIFICATIONSRequired EducationBachelor's Degree in a healthcare related field or an equivalent combination of education and experience.Required Experience5-7 yearsPreferred EducationGraduate degreeTo 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.#PJHPO Pay Range: $77,969 - $155,508 / ANNUAL
  *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.Required
  Preferred

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Keywords: Molina Healthcare, Milwaukee , Provider Contracts Manager, Executive , Caledonia, Wisconsin