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Director of Provider Contracts (Dallas)


The Director, Provider Contracts will plan, organize, staff, and coordinate the activities of the Plan’s Provider Contracts unit within the Network Management & Operations Department.

Work with Vice President, Network Management & Operations, senior management and Corporate to develop and implement standardized provider contracts and contracting strategies

DUTIES & RESPONSIBILITIES

· Manage, train and assist the Contract Managers and Contract Specialist(s).

Interview, hire and complete performance appraisals.

· In conjunction with the VP Network Mgt & Operations, oversee 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 the Plan’s membership.

· Advise 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.

· Utilize standardized contract templates and Pay for Performance strategies.

· Develop and maintain Reimbursement Tolerance Parameters (across multiple specialties/ geographies).

Oversee the development of new reimbursement models in concert with VP Network Management and Senior leadership.

Communicate new strategies to Corporate for input.

Utilize Standardized system (Emptoris) to track Contract Negotiation activity on an ongoing basis throughout the year.

· Participate on the management team and other committees addressing the strategic goals of the department and organization.

· Oversee the maintenance of all Provider Contract Templates.

Work 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.

Complies with required workplace safety standards.

Adheres to the company and/or departmental confidentiality standards and HIPAA compliance programs.

· Adheres to the company and/or departmental fraud and abuse prevention/detection policies and programs

· Excellent verbal and written communication skills

· Ability to abide by Molina’s policies

· Ability to maintain attendance to support required quality and quantity of work

· Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

· Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

REQUIREMENTS

Education:

· High School diploma or equivalent required.

Bachelor’s degree in a related field (Business Administration, etc.,) or equivalent combination of education and experien...

 


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