Director, Provider Contracts HP (Must Reside in California)
Molina Healthcare Long Beach, California; Los Angeles, California Job ID 2030940
Job Summary
Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, staffs, and coordinates the Provider Contracts activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.
Job Duties
Manages the Plan’s Provider Contracting functions and team members. Responsible for leading the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Contracting functions. This role primarily leads negotiations of contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract/Re-contracting with large scale entities involving custom reimbursement. Executes standardized Alternative Payment Method or Value Based Payment (VBP) contracts. Lead initiatives and activities issue escalations, network adequacy, and Joint Operating Committees.
• Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.
• In conjunction with direct management and senior leadership, oversees development of provider contracting strategies including VBP. This includes 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 in addition to identifying VBP provider targets to meet Molina goals.
• Leads the achievement of annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
• Leads preparation and negotiations of provider contracts and oversee negotiation of contracts, including VBP, in concert with established company guidelines with physicians, hospitals, and other health care providers.
• Utilizes standardized contract templates and VBP/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 including VBP program 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 contracting relationships with area agencies and community partners to support and advance Plan initiatives.
• Develops and implements contracting strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.
• Manages and provides coaching to Network Contracting Staff.
• Manages and evaluates team member performance; provides coaching, consultation, employee development, and recognition; ensures ongoing, appropriate staff training; holds regular team meetings to drive good communication and collaboration; and has responsibility for the selection, orientation and mentoring of new staff.
Job Qualifications
REQUIRED EDUCATION:
Bachelor’s Degree in a related field (Business Administration, etc.) or equivalent experience.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 7+ years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position
• 5+ years experience in provider contract negotiations in a managed healthcare setting including in negotiating different provider contract types and VBP models, i.e. physician, group and hospital contracting, etc.
• Working experience with, and strong knowledge of, various managed healthcare provider compensation and VBP methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc.
• Min. 2 years experience managing/supervising employees.
PREFERRED EDUCATION:
Master's Degree in a related field or an equivalent combination of education and experience
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: $111,893 - $218,192 / 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: 03/31/2025ABOUT OUR LOCATION
View Map- Pharmacy Technician, Clinical/MTM (Bilingual in Mandarin/Cantonese Preferred) Albany New York, Everett Washington, Seattle Washington, New York New York, Santa Fe New Mexico, Akron Ohio, Ohio, Fort Worth Texas, Austin Texas, Tacoma Washington, Milwaukee Wisconsin, Kenosha Wisconsin, Green Bay Wisconsin, Sioux City Iowa, Cedar Rapids Iowa, Caldwell Idaho, Owensboro Kentucky, Las Cruces New Mexico, Buffalo New York, Columbus Ohio, Bellevue Washington, Spokane Washington, Racine Wisconsin, Chandler Arizona, Tucson Arizona, Scottsdale Arizona, Iowa City Iowa, Idaho, Lexington-Fayette Kentucky, Warren Michigan, Bellevue Nebraska, New York, Syracuse New York, Cincinnati Ohio, San Antonio Texas, Dallas Texas, Orem Utah, Tampa Florida, St. Petersburg Florida, Augusta Georgia, Meridian Idaho, Kentucky, Sterling Heights Michigan, Grand Island Nebraska, Rio Rancho New Mexico, Houston Texas, Utah, Provo Utah, Vancouver Washington, Washington, Savannah Georgia, Nampa Idaho, Louisville Kentucky, Michigan, Rochester New York, Texas, Mesa Arizona, Orlando Florida, Jacksonville Florida, Georgia, Atlanta Georgia, Lincoln Nebraska, Albuquerque New Mexico, New Mexico, Yonkers New York, Dayton Ohio, Salt Lake City Utah, Madison Wisconsin, Miami Florida, Columbus Georgia, Des Moines Iowa, Davenport Iowa, Covington Kentucky, Grand Rapids Michigan, Detroit Michigan, Omaha Nebraska, Nebraska, Roswell New Mexico, West Valley City Utah, Phoenix Arizona, Florida, Iowa, Ann Arbor Michigan, Cleveland Ohio, Layton Utah, Wisconsin, Macon Georgia, Idaho Falls Idaho, Boise Idaho, Bowling Green Kentucky, Kearney Nebraska 03/12/2025
- Sr Spc, Provider Quality and Risk Adjustment- Remote (Must reside in Upstate, NY) Miami Florida, New Mexico, Las Cruces New Mexico, Iowa, Albany New York, Bowling Green Kentucky, Dallas Texas, Wisconsin, Lincoln Nebraska, Macon Georgia, Nampa Idaho, Des Moines Iowa, Boise Idaho, Vancouver Washington, Spokane Washington, Florida, Idaho Falls Idaho, Tucson Arizona, Madison Wisconsin, Scottsdale Arizona, Akron Ohio, Milwaukee Wisconsin, St. Petersburg Florida, Meridian Idaho, Sioux City Iowa, Santa Fe New Mexico, Grand Rapids Michigan, Sterling Heights Michigan, Davenport Iowa, Phoenix Arizona, Tacoma Washington, San Antonio Texas, Louisville Kentucky, Covington Kentucky, Ohio, Augusta Georgia, Utah, Nebraska, Chandler Arizona, Jacksonville Florida, Warren Michigan, Houston Texas, Atlanta Georgia, West Valley City Utah, Lexington-Fayette Kentucky, Mesa Arizona, Racine Wisconsin, Savannah Georgia, Bellevue Washington, Orem Utah, Cleveland Ohio, Everett Washington, Orlando Florida, Austin Texas, Texas, Albuquerque New Mexico, Cincinnati Ohio, Cedar Rapids Iowa, Bellevue Nebraska, Tampa Florida, Georgia, Columbus Ohio, Kearney Nebraska, Grand Island Nebraska, Rio Rancho New Mexico, Green Bay Wisconsin, Iowa City Iowa, Roswell New Mexico, Columbus Georgia, Kenosha Wisconsin, Omaha Nebraska, Fort Worth Texas, Ann Arbor Michigan, Caldwell Idaho, Salt Lake City Utah, Yonkers New York, Kentucky, Owensboro Kentucky, Michigan, Dayton Ohio, Arizona, Idaho, Provo Utah, Washington, Detroit Michigan, Layton Utah, Rochester New York, Syracuse New York, Buffalo New York 03/27/2025
- Sr. Program Specialist, Medicare - REMOTE Everett Washington, Albany New York, Michigan, Kearney Nebraska, Rio Rancho New Mexico, New York, Austin Texas, Madison Wisconsin, Macon Georgia, Caldwell Idaho, Detroit Michigan, New Mexico, Cleveland Ohio, Dallas Texas, Layton Utah, Bellevue Washington, Washington, Racine Wisconsin, Atlanta Georgia, Louisville Kentucky, Kentucky, Bowling Green Kentucky, Sterling Heights Michigan, Nebraska, Salt Lake City Utah, Tacoma Washington, Vancouver Washington, Milwaukee Wisconsin, Wisconsin, St. Petersburg Florida, Florida, Davenport Iowa, Iowa, Boise Idaho, Covington Kentucky, Idaho Falls Idaho, Warren Michigan, Roswell New Mexico, Las Cruces New Mexico, Buffalo New York, Utah, Provo Utah, Chandler Arizona, Augusta Georgia, Omaha Nebraska, Bellevue Nebraska, Santa Fe New Mexico, San Antonio Texas, Orem Utah, Kenosha Wisconsin, Tucson Arizona, Orlando Florida, Columbus Georgia, Georgia, Savannah Georgia, Iowa City Iowa, Idaho, Ann Arbor Michigan, Grand Rapids Michigan, Grand Island Nebraska, Cincinnati Ohio, Akron Ohio, Seattle Washington, Mesa Arizona, Scottsdale Arizona, Miami Florida, Des Moines Iowa, Lexington-Fayette Kentucky, Lincoln Nebraska, Albuquerque New Mexico, Yonkers New York, Syracuse New York, Ohio, Houston Texas, Tampa Florida, Sioux City Iowa, Cedar Rapids Iowa, Nampa Idaho, Meridian Idaho, Owensboro Kentucky, New York New York, Rochester New York, Dayton Ohio, Columbus Ohio, Fort Worth Texas, Texas, West Valley City Utah, Spokane Washington, Green Bay Wisconsin, Phoenix Arizona, Jacksonville Florida 03/26/2025
- Specialist, Appeals & Grievances Albany New York, Everett Washington, Columbus Ohio, Scottsdale Arizona, Sioux City Iowa, Idaho, New Mexico, Provo Utah, Vancouver Washington, Madison Wisconsin, Phoenix Arizona, Jacksonville Florida, Augusta Georgia, Iowa, Meridian Idaho, Lexington-Fayette Kentucky, Omaha Nebraska, Kearney Nebraska, Las Cruces New Mexico, Syracuse New York, Cincinnati Ohio, Texas, Austin Texas, St. Petersburg Florida, Kentucky, Grand Rapids Michigan, Rochester New York, Utah, Green Bay Wisconsin, Milwaukee Wisconsin, Chandler Arizona, Florida, Macon Georgia, Savannah Georgia, Sterling Heights Michigan, Albuquerque New Mexico, Roswell New Mexico, Buffalo New York, Ohio, Houston Texas, Salt Lake City Utah, West Valley City Utah, Tacoma Washington, Orlando Florida, Atlanta Georgia, Georgia, Davenport Iowa, Nampa Idaho, Bowling Green Kentucky, Louisville Kentucky, Ann Arbor Michigan, Lincoln Nebraska, Nebraska, Santa Fe New Mexico, New York New York, Yonkers New York, Fort Worth Texas, Layton Utah, Seattle Washington, Kenosha Wisconsin, Racine Wisconsin, Tucson Arizona, Mesa Arizona, Miami Florida, Des Moines Iowa, Cedar Rapids Iowa, Caldwell Idaho, Warren Michigan, Detroit Michigan, New York, Dayton Ohio, Orem Utah, Spokane Washington, Bellevue Washington, Washington, Wisconsin, Tampa Florida, Iowa City Iowa, Boise Idaho, Bellevue Nebraska, Rio Rancho New Mexico, San Antonio Texas, Dallas Texas, Columbus Georgia, Idaho Falls Idaho, Covington Kentucky, Owensboro Kentucky, Michigan, Grand Island Nebraska, Akron Ohio, Cleveland Ohio 03/26/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs