US Jobs US Jobs     UK Jobs UK Jobs     EU Jobs EU Jobs


Provider Contract Manager II


Molina Healthcare, Inc.

is searching for a Network Development Manager II for our Houston, TX location.

Plan, organize, staff, and assist in the supervision of 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.

Manage provider networks to ensure adequacy, quality and access.

Conduct high level negotiations/renegotiations with key providers and ensure outcomes fall within designated financial parameters.

Resolve contract interpretation issues.

Participate in internal/external meetings involving provider network activity.

The Network Development Manager II negotiates agreements with highly visible providers who are strategic to the success of the Plan, including, integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.

Duties and Responsibilities
* Negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
* Develops and maintains provider contracts in EMPTORIS contract management software.
* Targets and recruits additional providers to reduce member access grievances.
* Engages targeted contracted providers in renegotiation of rates and/or language.

Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.
* Maintains contractual relationships with significant/highly visible providers.
* Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.
* Evaluates provider network and implement strategic plans with the goal of meeting Molina’s network adequacy standards.
* Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
* Participates in fee schedule determinations including development of new reimbursement models.

Seeks input on new reimbursement models from Corporate Network Management and legal.
* Educates internal customers on provider contracts.
* Participates on the management team and other committees addressing the strategic goals of the department and organization.
* Complies with required workplace safety standards.

Knowledge, Skills and Abilities
· Knowledge of managed care culture and philosophy

· Strong analytical and reasoning abilities

· Excellent presentation and verbal and written communication skills

· Ability to abide by Molina’s policies

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

· Maintains confidentiality and com...

 


More Jobs from Molina Healthcare