Manager, Provider Contracts
Molina Healthcare Seattle, Washington; New York, New York; 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
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- Rep, Customer Experience - Bilingual Spanish Preferred (Remote in WA) - PST Shift Racine Wisconsin, Layton Utah, Boise Idaho, Ann Arbor Michigan, Scottsdale Arizona, Warren Michigan, Milwaukee Wisconsin, Madison Wisconsin, Mesa Arizona, Fort Worth Texas, Iowa, Ohio, Grand Rapids Michigan, Yonkers New York, Green Bay Wisconsin, Albany New York, Everett Washington, Bowling Green Kentucky, Sterling Heights Michigan, San Antonio Texas, Syracuse New York, Nampa Idaho, Rochester New York, Texas, Orlando Florida, Macon Georgia, Bellevue Nebraska, Columbus Ohio, Caldwell Idaho, Lincoln Nebraska, Houston Texas, Davenport Iowa, Grand Island Nebraska, Dayton Ohio, Chandler Arizona, Provo Utah, Vancouver Washington, Bellevue Washington, New Mexico, Lexington-Fayette Kentucky, Akron Ohio, Albuquerque New Mexico, Sioux City Iowa, Michigan, Orem Utah, Atlanta Georgia, Dallas Texas, Kenosha Wisconsin, Roswell New Mexico, Iowa City Iowa, Cleveland Ohio, Rio Rancho New Mexico, Nebraska, Austin Texas, Kearney Nebraska, New York, Salt Lake City Utah, Tucson Arizona, Augusta Georgia, Tampa Florida, Georgia, Louisville Kentucky, Miami Florida, Idaho Falls Idaho, Las Cruces New Mexico, Kentucky, Cincinnati Ohio, New York New York, St. Petersburg Florida, Columbus Georgia, Buffalo New York, Savannah Georgia, Idaho, Detroit Michigan, West Valley City Utah, Omaha Nebraska, Jacksonville Florida, Phoenix Arizona, Florida, Wisconsin, Santa Fe New Mexico, Arizona, Covington Kentucky, Des Moines Iowa, Cedar Rapids Iowa, Meridian Idaho, Owensboro Kentucky, Utah, Tacoma Washington, Spokane Washington, Seattle Washington 04/16/2025
- Rep, Customer Experience - Bilingual Spanish Preferred (Remote in Nevada) - PST Shift Albany New York, St. Petersburg Florida, Idaho, Green Bay Wisconsin, Bellevue Nebraska, New Mexico, Iowa, Buffalo New York, Tacoma Washington, Racine Wisconsin, Savannah Georgia, Phoenix Arizona, Ohio, Lexington-Fayette Kentucky, Detroit Michigan, Sioux City Iowa, Iowa City Iowa, Grand Rapids Michigan, Nampa Idaho, Vancouver Washington, Utah, Sterling Heights Michigan, Salt Lake City Utah, Orlando Florida, Everett Washington, Cleveland Ohio, Columbus Georgia, Austin Texas, Ann Arbor Michigan, San Antonio Texas, West Valley City Utah, Boise Idaho, Florida, Orem Utah, Miami Florida, Kentucky, Scottsdale Arizona, Bellevue Washington, Caldwell Idaho, Wisconsin, Atlanta Georgia, Covington Kentucky, Nebraska, Yonkers New York, Mesa Arizona, Akron Ohio, Provo Utah, Rio Rancho New Mexico, New York, Idaho Falls Idaho, New York New York, Las Cruces New Mexico, Tampa Florida, Omaha Nebraska, Spokane Washington, Albuquerque New Mexico, Jacksonville Florida, Cincinnati Ohio, Roswell New Mexico, Grand Island Nebraska, Syracuse New York, Seattle Washington, Cedar Rapids Iowa, Kearney Nebraska, Louisville Kentucky, Dallas Texas, Arizona, Rochester New York, Milwaukee Wisconsin, Meridian Idaho, Michigan, Warren Michigan, Chandler Arizona, Georgia, Texas, Davenport Iowa, Dayton Ohio, Fort Worth Texas, Columbus Ohio, Santa Fe New Mexico, Madison Wisconsin, Des Moines Iowa, Augusta Georgia, Washington, Kenosha Wisconsin, Owensboro Kentucky, Layton Utah, Bowling Green Kentucky, Macon Georgia, Lincoln Nebraska, Tucson Arizona, Houston Texas 04/16/2025
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