Provider Contracts Manager - Remote - Must reside in Massachusetts, Rhode Island or New Hampshire
Company: Molina Healthcare
Location: Lynn
Posted on: August 4, 2022
Job Description:
JOB DESCRIPTION Job Summary 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. KNOWLEDGE/SKILLS/ABILITIES
- In conjunction with Director/Manager Provider Contracts,
negotiates high priority physician group and facility contracts
using Preferred, Acceptable, Discouraged, Unacceptable (PADU)
guidelines.
- Develops and maintains provider contracts in APTTUS 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.
JOB QUALIFICATIONS Required Education Bachelor's Degree in a
healthcare related field or an equivalent combination of education
and experience. Required Experience 5-7 years Preferred Education
Graduate degree 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.
Keywords: Molina Healthcare, Lynn , Provider Contracts Manager - Remote - Must reside in Massachusetts, Rhode Island or New Hampshire, Executive , Lynn, Massachusetts
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