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Director, Provider Contracts (Remote in Iowa)

Company: Molina Healthcare
Location: Des Moines
Posted on: November 25, 2022

Job Description:

KNOWLEDGE/SKILLS/ABILITIESPlans, 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.
    JOB QUALIFICATIONSRequired EducationBachelor'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 EducationMaster's DegreePreferred Experience6+ years in Provider Network contracting#PJCore

      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: - $97,298.55 - $189,732.18 a year**Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Keywords: Molina Healthcare, Des Moines , Director, Provider Contracts (Remote in Iowa), Executive , Des Moines, Iowa

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