National Contracting Director
Molina Healthcare Albany, New York; Everett, Washington; Seattle, Washington; New York, New York; Grand Rapids, Michigan; Grand Island, Nebraska; Lincoln, Nebraska; Rio Rancho, New Mexico; Austin, Texas; Tucson, Arizona; Des Moines, Iowa; Sioux City, Iowa; Caldwell, Idaho; Lexington-Fayette, Kentucky; Michigan; Nebraska; Omaha, Nebraska; Albuquerque, New Mexico; Orem, Utah; Provo, Utah; Bellevue, Washington; Spokane, Washington; Green Bay, Wisconsin; Kenosha, Wisconsin; Mesa, Arizona; St. Petersburg, Florida; Atlanta, Georgia; Idaho; Owensboro, Kentucky; Warren, Michigan; Kearney, Nebraska; New Mexico; Syracuse, New York; Dallas, Texas; Houston, Texas; Orlando, Florida; Cedar Rapids, Iowa; Ann Arbor, Michigan; Buffalo, New York; New York; Vancouver, Washington; Georgia; Savannah, Georgia; Macon, Georgia; Davenport, Iowa; Idaho Falls, Idaho; Louisville, Kentucky; Bowling Green, Kentucky; Cleveland, Ohio; Dayton, Ohio; Columbus, Ohio; Texas; Layton, Utah; Racine, Wisconsin; Kentucky; Bellevue, Nebraska; Yonkers, New York; Akron, Ohio; Ohio; Madison, Wisconsin; Scottsdale, Arizona; Phoenix, Arizona; Jacksonville, Florida; Florida; Augusta, Georgia; Meridian, Idaho; Covington, Kentucky; Santa Fe, New Mexico; Las Cruces, New Mexico; Rochester, New York; San Antonio, Texas; Tacoma, Washington; Washington; Chandler, Arizona; Miami, Florida; Tampa, Florida; Columbus, Georgia; Iowa City, Iowa; Boise, Idaho; Detroit, Michigan; Sterling Heights, Michigan; Roswell, New Mexico; Cincinnati, Ohio; Fort Worth, Texas; Salt Lake City, Utah; Utah; West Valley City, Utah; Milwaukee, Wisconsin; Wisconsin; Iowa; Nampa, Idaho Job ID 2030335***Remote and must live in the United States***
Job Description
Job Summary
Molina's Provider Contracting function provides guidance, signature support services, standards and resources to help Molina Healthcare successfully establish and maintain distinct high performing networks of compassionate and culturally sensitive providers who:
• Are aligned with our mission to provide quality health services to financially vulnerable families and individuals covered by government programs;
• Help meet or exceed applicable access criteria and adequacy standards for covered services;
• Agree to sign standard provider services agreements approved by applicable state/federal agencies and built on Molina's business standards that include sustainable value-based reimbursements; and
• Are committed to providing quality healthcare for low income Members in an efficient and caring manner.'
Knowledge/Skills/Abilities
• Under the leadership of the AVP, Provider Network Management & Operations, oversees development and implementation of provider network and contract strategies, identifying those specialties and geographic locations upon which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of Molina membership.
• Develops and maintains a standard provider reimbursement strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies). Obtains input from Corporate, Legal and other stakeholders regarding new reimbursement models and oversees their development.
• Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the enterprise contract management system (Emptoris).
• Directs the preparation of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines with physicians, hospitals, and other health care providers.
• Contributes as a key member of the department's leadership team and participates in committees addressing the department's strategic goals and organization.
• Oversees the maintenance of all provider contract information and provider contract templates and ensures that contracts can be configured within the QNXT system. Works with Legal, Corporate and other stakeholders as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Monitors and reports network adequacy for Medicare and Medicaid services.
• Develops strategies to improve EDI/MASS rates.
• Educates and works with assigned state Health Plans on any corporate changes or initiatives as necessary.
• Works with assigned national vendors to improve contractual terms and maintain positive relationships.
• Provides national contracts support for other Molina departments/functions, including: Provider Services (and activities with provider association(s) and Joint Operating Committee management); Delegation Oversight; Provider Network Administration (provider information management and business analyses of national contracts/benefits to support accurate configuration for claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances.
• Coordinates with Corporate and Business Development teams to ensure that Molina grows faster (profitable growth) than our competitors in target new markets and expansion opportunities.
• Provides training and guidance as needed to the Contract Managers and Contract Specialist(s).
• Helps develop and utilize standardized contract templates and Pay for Performance strategies.
• Utilizes sound reporting and analytical tools to develop and refine strategic work plans..
Job Qualifications
Required Education
Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.
Required Experience
7 - 10 years minimum experience in Healthcare Administration, Managed Care, and/or Provider Network Mgmt & Operations with an emphasis on value based provider contracting.
Required License, Certification, Association
N/A
Preferred Education
Master's Degree
Preferred Experience
3-5 years minimum experience in contracting with hospitals, physician groups, high volume specialists and ancillary providers.
Preferred License, Certification, Association
N/A
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.
#PJCore
#LI-AC1
Pay Range: $107,028 - $250,446 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 02/27/2025ABOUT OUR LOCATION
View Map- Field Case Manager, LTSS - Bachelor or Masters degree Ottumwa Iowa, Blakesburg Iowa, Floris Iowa, Batavia Iowa, Libertyville Iowa, Birmingham Iowa, Lockridge Iowa, Fairfield Iowa, Bloomfield Iowa, Iowa City Iowa 05/12/2025
- Analyst, Risk & Quality Reporting (Remote in CA) Los Angeles California, San Diego California, Riverside California, San Bernardino California, Sacramento California 04/17/2025
- Manager, Medical Economics (Marketplace) - REMOTE Albany New York, Everett Washington, Idaho, Iowa, Kentucky, Florida, Michigan, New York, Georgia, Texas, Wisconsin, Ohio, Washington, Nebraska, New Mexico, Utah, Spokane Washington, Tampa Florida, Racine Wisconsin, Milwaukee Wisconsin, Idaho Falls Idaho, Roswell New Mexico, Grand Rapids Michigan, Buffalo New York, Bellevue Nebraska, Grand Island Nebraska, Phoenix Arizona, Santa Fe New Mexico, Albuquerque New Mexico, Orem Utah, Warren Michigan, Orlando Florida, Louisville Kentucky, Cincinnati Ohio, Columbus Georgia, Atlanta Georgia, Madison Wisconsin, Austin Texas, Las Cruces New Mexico, West Valley City Utah, Layton Utah, Miami Florida, New York New York, Omaha Nebraska, Boise Idaho, Meridian Idaho, Mesa Arizona, Rio Rancho New Mexico, Ann Arbor Michigan, Yonkers New York, Owensboro Kentucky, Lexington-Fayette Kentucky, Kearney Nebraska, Davenport Iowa, Des Moines Iowa, Cleveland Ohio, Columbus Ohio, Savannah Georgia, Chandler Arizona, Scottsdale Arizona, San Antonio Texas, Dallas Texas, Fort Worth Texas, Salt Lake City Utah, Bellevue Washington, Seattle Washington, Vancouver Washington, Rochester New York, Covington Kentucky, Sioux City Iowa, Dayton Ohio, Kenosha Wisconsin, Nampa Idaho, Tacoma Washington, St. Petersburg Florida, Syracuse New York, Bowling Green Kentucky, Lincoln Nebraska, Cedar Rapids Iowa, Akron Ohio, Macon Georgia, Houston Texas, Detroit Michigan, Jacksonville Florida, Iowa City Iowa, Augusta Georgia, Green Bay Wisconsin, Caldwell Idaho, Tucson Arizona, Provo Utah, Sterling Heights Michigan, Long Beach California 04/14/2025
- Rep, Customer Experience (Part Time, Bilingual preferred) Doral Florida, Washington, Nebraska, New Mexico, Miami Florida, Kissimmee Florida, Jacksonville Florida, East Naples Florida, Florida, Idaho, Michigan, Kentucky, Wisconsin, Ohio, Iowa, Arizona, Utah, Georgia, New York, Texas 04/08/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs