Director, Provider Contracts (Georgia)
Molina Healthcare Boise, Idaho; Ann Arbor, Michigan; Mesa, Arizona; Rio Rancho, New Mexico; Florida; Lexington-Fayette, Kentucky; Utah; Houston, Texas; Santa Fe, New Mexico; Omaha, Nebraska; Nampa, Idaho; Iowa; Arizona; Phoenix, Arizona; Louisville, Kentucky; Grand Island, Nebraska; Dayton, Ohio; Yonkers, New York; Owensboro, Kentucky; Dallas, Texas; Jacksonville, Florida; Provo, Utah; Fort Worth, Texas; Seattle, Washington; Wisconsin; Tacoma, Washington; New York, New York; Layton, Utah; Davenport, Iowa; Tampa, Florida; Albuquerque, New Mexico; Idaho; Spokane, Washington; Savannah, Georgia; Atlanta, Georgia; Macon, Georgia; Columbus, Georgia; Augusta, Georgia; Bellevue, Washington; Kentucky; Orlando, Florida; Syracuse, New York; Sioux City, Iowa; Bowling Green, Kentucky; Scottsdale, Arizona; Cedar Rapids, Iowa; Detroit, Michigan; Salt Lake City, Utah; Nebraska; Grand Rapids, Michigan; Cleveland, Ohio; Ohio; Bellevue, Nebraska; Lincoln, Nebraska; New York; Miami, Florida; Sterling Heights, Michigan; Texas; Vancouver, Washington; Green Bay, Wisconsin; Caldwell, Idaho; New Mexico; Buffalo, New York; Tucson, Arizona; Kenosha, Wisconsin; San Antonio, Texas; Chandler, Arizona; Cincinnati, Ohio; Milwaukee, Wisconsin; Michigan; Roswell, New Mexico; Akron, Ohio; Des Moines, Iowa; Madison, Wisconsin; West Valley City, Utah; Austin, Texas; St. Petersburg, Florida; Washington; Racine, Wisconsin; Iowa City, Iowa; Rochester, New York; Las Cruces, New Mexico; Kearney, Nebraska; Warren, Michigan; Idaho Falls, Idaho; Orem, Utah; Covington, Kentucky; Meridian, Idaho Job ID 2031386***Remote and must live in Georgia***
KNOWLEDGE/SKILLS/ABILITIES
Plans, organizes, staffs, and coordinates the Provider Contracts activities for contracts at a National Level. 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.
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.
Pay Range: $97,299 - $227,679 / 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: 04/11/2025ABOUT OUR LOCATION
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