Director, Provider Contracts

Knowledge/Skills/Abilities

Plans, organizes, staffs, and coordinates the Provider Contracts activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.

• Monitors and reports network adequacy for Medicare and Medicaid services.
• In conjunction with direct management and senior leadership, 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 members and patients.
• 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.
• 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 direct management and senior leadership/management.
• Communicates new strategies to corporate provider network leadership for input.
• Utilize standardized system(s) 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 as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Manages the relationship with area agencies and community provider partners to support and advance Plan initiatives.
• Develops and implements strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.

Qualifications Job Qualifications Required Education

Bachelor’s Degree in a related field (Business Administration, etc.) or equivalent experience.

Required Experience

• 7+ years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services.
• Min. 2 years experience managing/supervising employees.

Preferred Education

Master’s Degree

Preferred Experience

6+ years in Provider Network contracting

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.