Director of Provider Contracts - Remote

3 Days Old

Job Summary The Director of Provider Contracts at Molina Health Plan will drive network strategy and development focused on adequacy, financial performance, and operational excellence, all while aligning with Molina Healthcare's mission and strategic plan. This role ensures compliance with federal, state, and local regulations while leading the day-to-day operations of the Provider Contracts team for the health plan. Key Responsibilities: Manage and oversee the Provider Contracting functions and team members. Lead negotiation efforts with Complex Provider Communities to establish high-quality and cost-effective provider contracts. Execute standardized Alternative Payment Method or Value Based Payment (VBP) contracts. Address initiative activities, network adequacy, and escalations effectively. Prepare and negotiate contracts in line with corporate guidelines with healthcare providers. Collaborate with teams to identify specialty areas and geographic locations for resource concentration to meet member needs. Lead cost control strategies to positively impact the Medical Care Ratio (MCR). Develop and maintain reimbursement models alongside senior leadership. Utilize tracking systems for ongoing contract negotiation activity throughout the year. Communicate new strategies effectively with corporate provider network leadership for insights. Provide coaching, development, and recognition to Network Contracting Staff and manage performance evaluations. Ensure adherence to compliance with state, federal, NCQA, and HEDIS standards. Qualifications: Required Education: Bachelor's Degree in a relevant field or equivalent experience. Required Experience: At least 7 years in Healthcare Administration, Managed Care, Provider Contracting, and/or Provider Services, with 2 years in a leadership role. Over 5 years of experience in provider contract negotiations, including experience with various contract types and VBP models. Strong knowledge of managed healthcare provider compensation models, particularly in Medicaid and Medicare. Preferred Education: Master's Degree in a related field or equivalent combination of education and experience. Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $97,299 - $189,732.18 / ANNUAL. Actual compensation may vary based on geographic location, work experience, education, and/or skill level.
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Location:
Houston, TX, United States
Category:
Management Occupations

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