Negotiates agreements with highly visible providers who are strategic to the success of the Plan, including, integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.
• Negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
• Develops and maintains provider contracts in EMPTORIS contract management software.
• Targets and recruits additional providers to reduce member access grievances.
• 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.
• Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.
• 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.
• Complies with required workplace safety standards.
• Knowledge of managed care culture and philosophy
• Strong analytical and reasoning abilities
• Excellent presentation and verbal and written communication skills
• Ability to abide by Molina’s policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintains confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and fraud and abuse prevention detection policies and procedures
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.
5 years experience in Managed Care (including Medicaid, Medicare/Medicare Advantage and other State governed plans).
3 years experience in contract negotiations.
Bachelor’s Degree with Master’s Degree
5 – 10+ years of experience negotiating highly visible, strategic provider agreements.
To all current Molina employees if you are interested in applying for this position please apply through the
job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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