Job Description

**JOB DESCRIPTION** **Job Summary** Negotiates National agreements with highly visible providers including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers. **KNOWLEDGE/SKILLS/ABILITIES** + In conjunction with Director/Manager Provider Contracts, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines. + Develops and maintains provider contracts in APTTUS 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. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in a healthcare related field or an equivalent combination of education and 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. Pay Range: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Tags

Contract work, Work experience placement,

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