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As part of Molina’s response to the COVID-19 pandemic, unless otherwise prohibited by law, new hires with a start date of November 1, 2021 or later will be required to be fully vaccinated.

Dir, Provider Contracts

Molina Healthcare Reno, Nevada Job ID 2009152
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KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):

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.

• 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.

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.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

PREFERRED EDUCATION:

Master's Degree

PREFERRED EXPERIENCE:

6+ years in Provider Network contracting

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

N/A

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: 07/13/2021

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