Mgr Provider Contracts (4562BR) Columbus, Ohio

Job Summary

Plans, organizes, staffs, and assists in the supervision of the activities of the Plan’s Provider Contracts unit within the Network Management & Operations Department.  Works with Vice President or Director Network Management & Operations, senior management and Corporate to develop and implement standardized provider contracts and contracting strategies. Manages provider networks to ensure adequacy, quality and access. Conducts high level negotiations/renegotiations with key providers and ensure outcomes fall within designated financial parameters. Resolves contract interpretation issues. Participates in internal/external meetings involving provider network activity.

Essential Functions

• Manages, trains and assists the Contract Managers and Contract Specialist(s).  Interviews, hires and completes performance appraisals.
• In conjunction with the VP or Director Network Management & Operations, oversees development of provider contracting strategies, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan’s membership.
• Advises in preparation and negotiations of provider contracts and oversee negotiation of contracts in concert with established company guidelines with physicians, hospitals, and other health care providers.
• Achieves annual savings through recontracting initiatives.  Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
• Utilizes standardized contract templates and Pay for Performance strategies.
• Develops and maintains Reimbursement Tolerance Parameters (across multiple specialties/ geographies).  Oversees the development of new reimbursement models in concert with VP Network Management and Senior leadership. Communicates new strategies to Corporate for input. Utilize Standardized system (Emptoris) to track Contract Negotiation activity on an ongoing basis throughout the year.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.
• Oversees the maintenance of all Provider Contract Templates.  Works 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.
• Complies with required workplace safety standards.
• Adheres to the company and/or departmental confidentiality standards and HIPAA compliance programs.
• Adheres to the company and/or departmental fraud and abuse prevention/detection policies and programs.
State Plan / Department Specific Duties and Responsibilities (List all essential duties other than those listed above in order of importance)
• Ensures compliance with all Medicare and Medicaid provider panel and network capacity and adequacy requirements.  Produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
• Develops and implements strategies to reduce impactible member access grievances.  Monitors and adjusts strategy implementation as needed to achieve desire goals and reduce impactible member access grievances.

Knowledge/Skills/Abilities

• Excellent verbal and written communication skills with ability to prepare and execute group presentations
• Demonstrated knowledge of reimbursement methodologies, managed care processes, and managed care lines of business, including Medicaid, Managed Medicaid, Medicare and Commercial HMO products
• Contract negotiation skills
• Ability to work independently
• Demonstrated competency in Microsoft Office (MS Word, Excel, PowerPoint)
• Ability to abide by Molina’s policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers



Required Education: 
 Bachelor’s Degree in a related field (Business Administration, etc.,) or equivalent experience
                                                                                                           
Required Experience:     
5 years in managed care with contract negotiations experience.
3 years of supervisory experience.                                                                                                                  
Required Licensure/Certification:
N/A                                                                                                                           
 
Preferred Education:
Master’s Degree  
 
Preferred Experience:
6+ years of experience in Managed Care contracting negotiations for all provider types-physician, hospital and ancillary providers.
3 years experience in hospital and ancillary provider contracting.   
 
Preferred Licensure/Certification:
N/A              
 



State Specific Requirements

·Lead and coordinate implementation of novel reimbursement strategies including bundled payment.

·Develop new models of reimbursement that capture cost and quality outcomes.

·Develop analytic reporting tools to track outcomes for contracted entities and internal review.

·Develop provider tools such as scorecards and other metrics for effective provider management of patient populations.

·Coordinate efforts with multiple departments to advance PCMH, Health Homes and other patient-centered programs.

·Be a resource to senior leadership and management on payment reform.

·Work closely and collaboratively with multiple departments such as Finance & Analytics, Quality Improvement and Network Management.




















To all current Molina employees if you are interested in applying for this position please apply through the intranet 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.

To apply, please click here