Job Description

***Remote and must libe in the United States***

Provides deep subject matter expertise and leadership for national contracting activities across the Molina enterprise. Supports network strategy and development with respect to adequacy, financial performance, and operational performance. Develops contracting standards and resources designed to enable Molina to establish and maintain distinct high-performing networks of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values. Responsible for negotiating complex national agreements with highly visible providers including integrated delivery systems, hospitals and physician groups.

Essential Job Duties

• Oversees the development and implementation of provider network and contract strategies; identifies 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 Molina membership.

• Develops and maintains a standard provider reimbursement strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); obtains input from corporate, legal and other stakeholders regarding new reimbursement models and oversees development accordingly.

• Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the enterprise contract management system.

• Directs the preparation of provider contracts and oversees negotiation of contracts in alignment with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers.

• Contributes as a key member of the department’s leadership team and participates in committees to address department and organizational strategic goals.

• Oversees the maintenance of all provider contract information and provider contract templates and ensures that contracts can be configured within the QNXT system; collaborates with legal, corporate and other stakeholders as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.

• Monitors and reports network adequacy for Medicare and Medicaid services.

• Develops strategies to improve EDI/MASS rates.

• Educates and works with assigned state health plans on any corporate changes or initiatives as necessary.

• Collaborates with assigned national vendors to improve contractual terms and maintain positive relationships.

• Provides national contracts support for other Molina departments/functions, including: provider services (and activities with provider association(s) and joint operating committee (JOC) leadership); delegation oversight; provider network administration (provider information management and business analyses of national contracts/benefits to support accurate configuration for claims payment); provider/member inquiry research and resolution; and provider/member appeals and grievances.

• Coordinates with corporate and business development teams to ensure that Molina grows faster (profitable growth) than competitors in target new markets and expansion opportunities.

• Provides training and guidance as needed to contracting staff.

• Helps develop and utilize standardized contract templates and pay-for-performance (P4P) (P4P) strategies.

• Utilizes sound reporting and analytical tools to develop and refine strategic work plans.

• Provides training, mentoring and support to new and existing contracting team members.

Required Qualifications

• At least 8 years of experience in provider network management/provider contracting, specifically in value-based payment (VBP) reimbursement, or equivalent combination of relevant education and experience.

• 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.

• Strong negotiation and relationship building capabilities.

• Ability to navigate complex regulatory environments.

• Organizational skills and attention to detail.

• Strong data-driven decision-making skills, and analytical abilities.

• Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.

• Strong ability to manage multiple tasks and deadlines effectively.

• Strong verbal and written communication skills.

• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Experience contracting with hospitals, physician groups, high-volume specialists and ancillary providers.

• Experience negotiating alternative payment models (APMs).

• Deep experience with Medicaid, Medicare, and Marketplace government-sponsored programs.

• Management/leadership experience.

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