_**Remote and must live in the United States_**
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
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In conjunction with Director/Manager Provider Contracts, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
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Develops and maintains provider contracts in APTTUS contract management software.
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Targets and recruits additional providers to reduce member access grievances.
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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.
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Maintains contractual relationships with significant/highly visible providers.
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Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.
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Evaluates provider network and implement strategic plans with the goal of meeting Molina's network adequacy standards.
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Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
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Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal.
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Educates internal customers on provider contracts.
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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.
