Provider Contracts Manager, (Remote - Ideal candiates will reside in the Grand Rapids, MI area)
Company: Molina Healthcare
Location: Irvine
Posted on: June 25, 2022
Job Description:
For Immediate Consideration: Please Apply directly to our
website:https://careers.molinahealthcare.com/job/grand-rapids/provider-contracts-manager-grand-rapids-mi/21726/27263447168Negotiates
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.Required EducationBachelor's Degree in a healthcare
related field or an equivalent combination of education and
experience.Required Experience5-7 years Preferred EducationGraduate
degree
Keywords: Molina Healthcare, Irvine , Provider Contracts Manager, (Remote - Ideal candiates will reside in the Grand Rapids, MI area), Hospitality & Tourism , Irvine, California
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