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Provider Contracts Manager
Molina Healthcare • Las Cruces, NM 88006 • Posted 3 days ago
Provider Contracts Manager
Molina Healthcare • Las Cruces, NM 88006 • Posted 3 days ago
In-person • Full-time • $77,969-$155,508/yr • Senior Level
**JOB DESCRIPTION**
**Job Summary**
Negotiates 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 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.
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Negotiates 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 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.
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.