Job Details

**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.