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Director, Provider Contracts

Expired Job

Molina Healthcare Syracuse , NY 13201

Posted 2 months ago

Knowledge/Skills/Abilities

Plans, 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 Qualifications

Required Education

Bachelor'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 Education

Master's Degree

Preferred Experience
6 years in Provider Network contracting

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.


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Director, Provider Contracts

Expired Job

Molina Healthcare