Manager, Provider Contracts
Molina Healthcare Buffalo, New York; New York; Cleveland, Ohio; Houston, Texas; Salt Lake City, Utah; Orlando, Florida; Florida; Tampa, Florida; Augusta, Georgia; Cedar Rapids, Iowa; Nampa, Idaho; Lexington-Fayette, Kentucky; Las Cruces, New Mexico; Santa Fe, New Mexico; Syracuse, New York; Texas; Provo, Utah; Racine, Wisconsin; Chandler, Arizona; Kentucky; Nebraska; Roswell, New Mexico; Washington; Kenosha, Wisconsin; Davenport, Iowa; Idaho Falls, Idaho; Meridian, Idaho; Covington, Kentucky; Bellevue, Nebraska; Omaha, Nebraska; Columbus, Ohio; Madison, Wisconsin; Wisconsin; Tucson, Arizona; Macon, Georgia; Atlanta, Georgia; Savannah, Georgia; Iowa City, Iowa; Caldwell, Idaho; Louisville, Kentucky; Detroit, Michigan; Michigan; Grand Island, Nebraska; Yonkers, New York; Akron, Ohio; Utah; Scottsdale, Arizona; Columbus, Georgia; Idaho; Owensboro, Kentucky; Sterling Heights, Michigan; Kearney, Nebraska; Ohio; Dayton, Ohio; San Antonio, Texas; Austin, Texas; West Valley City, Utah; Layton, Utah; Orem, Utah; Vancouver, Washington; Tacoma, Washington; Green Bay, Wisconsin; Milwaukee, Wisconsin; Mesa, Arizona; Jacksonville, Florida; Des Moines, Iowa; Sioux City, Iowa; Bowling Green, Kentucky; Ann Arbor, Michigan; Rochester, New York; Cincinnati, Ohio; Fort Worth, Texas; Spokane, Washington; Phoenix, Arizona; St. Petersburg, Florida; Miami, Florida; Georgia; Iowa; Lincoln, Nebraska; Albuquerque, New Mexico; New Mexico; Rio Rancho, New Mexico; Dallas, Texas; Bellevue, Washington; Boise, Idaho; Warren, Michigan; Grand Rapids, Michigan Job ID 2030336***Remote and must live in the United States***
Job Description
Job Summary
Molina National Level Contracting jobs are responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
Knowledge/Skills/Abilities
• In conjunction with the Director, Provider Contracts, develops health plan-specific provider contracting strategies, identifying 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 the Plan's patients or members.
• Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, MLTSS and other health care providers.
• Assists in achieving annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
• Utilizes standardized contract templates and Pay for Performance strategies.
• Utilizes established Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with Director.
• Oversees the maintenance of all Provider and payer Contract Templates. Works with legal and Corporate Network Management on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines. Produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
• Develops and implements strategies to minimize the company's financial exposure. Monitors and adjusts strategy implementation as needed to achieve desire goals and reduce minimize the company's financial exposure..
Job Qualifications
Required Education
Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent 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.
#PJCore
Pay Range: $77,969 - $171,058 / 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- Dir, Business Development - ICHRA Miami Florida, Iowa City Iowa, Akron Ohio, Albuquerque New Mexico, Ann Arbor Michigan, Atlanta Georgia, Chicago Illinois, Dallas Texas, San Antonio Texas, Houston Texas, Springfield Illinois, Bridgeport Connecticut, Hartford Connecticut, New Haven Connecticut, Phoenix Arizona, Tampa Florida, Milwaukee Wisconsin, Boise Idaho, Detroit Michigan 03/31/2025
- Director, Payment Integrity (Analytics) Bellevue Nebraska, New York, Ohio, San Antonio Texas, Utah, Kenosha Wisconsin, Racine Wisconsin, Tucson Arizona, Orlando Florida, Atlanta Georgia, Boise Idaho, Owensboro Kentucky, Louisville Kentucky, Kentucky, Warren Michigan, Michigan, Grand Rapids Michigan, Grand Island Nebraska, Buffalo New York, Syracuse New York, Houston Texas, Dallas Texas, Seattle Washington, Tacoma Washington, Spokane Washington, Phoenix Arizona, Florida, Miami Florida, Macon Georgia, Des Moines Iowa, Las Cruces New Mexico, Yonkers New York, Bellevue Washington, Tampa Florida, Iowa, Davenport Iowa, Idaho, Bowling Green Kentucky, Detroit Michigan, New Mexico, Akron Ohio, Columbus Ohio, Fort Worth Texas, West Valley City Utah, Orem Utah, Salt Lake City Utah, Milwaukee Wisconsin, Chandler Arizona, Lexington-Fayette Kentucky, Sterling Heights Michigan, Lincoln Nebraska, New York New York, Dayton Ohio, Austin Texas, Provo Utah, Layton Utah, Washington, Madison Wisconsin, Mesa Arizona, Georgia, Columbus Georgia, Cedar Rapids Iowa, Kearney Nebraska, Santa Fe New Mexico, Rochester New York, Vancouver Washington, St. Petersburg Florida, Savannah Georgia, Augusta Georgia, Sioux City Iowa, Omaha Nebraska, Albuquerque New Mexico, Wisconsin, Green Bay Wisconsin, Scottsdale Arizona, Jacksonville Florida, Iowa City Iowa, Idaho Falls Idaho, Caldwell Idaho, Ann Arbor Michigan, Nebraska, Roswell New Mexico, Rio Rancho New Mexico, Cincinnati Ohio, Cleveland Ohio, Texas, Nampa Idaho, Meridian Idaho, Covington Kentucky 03/28/2025
- Sr Actuarial Analyst (Medicare) - REMOTE Bellevue Nebraska, Yonkers New York, Cleveland Ohio, Ohio, Houston Texas, Spokane Washington, Macon Georgia, Des Moines Iowa, Davenport Iowa, Boise Idaho, Idaho Falls Idaho, Kentucky, Detroit Michigan, Omaha Nebraska, New Mexico, Rio Rancho New Mexico, Syracuse New York, Cincinnati Ohio, Provo Utah, Scottsdale Arizona, Orlando Florida, Nampa Idaho, Owensboro Kentucky, Louisville Kentucky, Bowling Green Kentucky, Warren Michigan, Sterling Heights Michigan, Santa Fe New Mexico, Roswell New Mexico, Tucson Arizona, Iowa, Meridian Idaho, Lexington-Fayette Kentucky, Ann Arbor Michigan, Michigan, Albuquerque New Mexico, Rochester New York, Vancouver Washington, Texas, Mesa Arizona, St. Petersburg Florida, Idaho, Las Cruces New Mexico, New York, Kenosha Wisconsin, Racine Wisconsin, Dayton Ohio, Austin Texas, San Antonio Texas, West Valley City Utah, Layton Utah, Tampa Florida, Atlanta Georgia, Augusta Georgia, Caldwell Idaho, Lincoln Nebraska, Miami Florida, Buffalo New York, Wisconsin, Green Bay Wisconsin, Akron Ohio, Fort Worth Texas, Tacoma Washington, Georgia, Covington Kentucky, Washington, Madison Wisconsin, Columbus Ohio, Salt Lake City Utah, Chandler Arizona, Savannah Georgia, Columbus Georgia, Sioux City Iowa, Iowa City Iowa, Cedar Rapids Iowa, Grand Rapids Michigan, Nebraska, Grand Island Nebraska, Bellevue Washington, Milwaukee Wisconsin, Dallas Texas, Utah, Orem Utah, Phoenix Arizona, Florida, Jacksonville Florida, Kearney Nebraska 03/17/2025
- Sr Finance Analyst - Remote (OH Health Plan) St. Petersburg Florida, Georgia, Boise Idaho, Covington Kentucky, Omaha Nebraska, New Mexico, Rio Rancho New Mexico, Buffalo New York, Cincinnati Ohio, Akron Ohio, Texas, Washington, Bellevue Washington, Florida, Iowa, Owensboro Kentucky, Louisville Kentucky, Lincoln Nebraska, Nebraska, Albuquerque New Mexico, Spokane Washington, Green Bay Wisconsin, Milwaukee Wisconsin, Mesa Arizona, Miami Florida, Nampa Idaho, Rochester New York, Fort Worth Texas, Provo Utah, Orlando Florida, Tampa Florida, Sioux City Iowa, Cedar Rapids Iowa, Idaho, Grand Island Nebraska, Bellevue Nebraska, Yonkers New York, Ohio, Dallas Texas, Vancouver Washington, Racine Wisconsin, Kenosha Wisconsin, Michigan, Grand Rapids Michigan, Detroit Michigan, New York, Tucson Arizona, Phoenix Arizona, Scottsdale Arizona, Augusta Georgia, Savannah Georgia, Columbus Georgia, Macon Georgia, Kentucky, Sterling Heights Michigan, Roswell New Mexico, Cleveland Ohio, Chandler Arizona, Jacksonville Florida, Atlanta Georgia, Idaho Falls Idaho, Lexington-Fayette Kentucky, Warren Michigan, Santa Fe New Mexico, Las Cruces New Mexico, Dayton Ohio, Columbus Ohio, San Antonio Texas, Houston Texas, Utah, Orem Utah, Iowa City Iowa, Des Moines Iowa, Bowling Green Kentucky, Kearney Nebraska, Syracuse New York, Austin Texas, Salt Lake City Utah, West Valley City Utah, Layton Utah, Wisconsin, Davenport Iowa, Caldwell Idaho, Meridian Idaho, Ann Arbor Michigan, Tacoma Washington, Madison Wisconsin 02/20/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs