Manager, Health Plan Provider Contracts (Value-Based Contracts)
JOB DESCRIPTION Job Summary
Molina Health Plan Provider Network Contracting jobs are responsible for the value-based payments (VBP) network strategy and development with respect to financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for contracting/re-contracting of complex contracts with Alternative Payment Methods including but not limited to Value Based and Capitated payments for Hospitals, Independent Practice Associations, and complex Behavioral Health arrangements. Manages VBPs through negotiation, implementation and management. Entails value-based contracting negotiations and understanding of alternative arrangements. Maintains critical Complex provider information on claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validates data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Manages the exchange of data and reporting for all state-led VBPs.
Essential Job Duties
• Oversees the plan’s provider value-based contracting function; collaborates with other operational departments and functional business unit stakeholders on various provider value-based contracting activities.
• Negotiates contracts with the complex provider community that result in high quality, cost-effective and marketable providers.
• Executes standardized alternative payment model (APM) or value-based payment (VBP) contracts.
• Issues escalations and supports joint operating committees (JOCs), and delegation oversight.
• In conjunction with contracting leadership, develops health plan-specific provider value-based contracting strategies and assists in identifying VBP provider targets to meet Molina goals.
• Assists in achieving annual savings through recontracting initiatives; implements cost-control initiatives to positively influence the medical cost ratio (MCR) in each contracted region.
• Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, managed long-term services and supports (MLTSS) and other health care providers.
• Utilizes established reimbursement tolerance parameters (across multiple specialties/ geographies),and oversees the development of new reimbursement models.
• Ensures compliance with applicable provider value-based contracting requirements; produces and monitors recurring reports to track and monitor compliance with state requirements.
• Develops and implements strategies to minimize the company’s financial exposure; monitors and adjusts strategy implementation as needed to achieve desired goals and reduce minimize the company’s financial exposure.
• Assesses contract language for compliance with corporate standards and regulatory requirements and review revised language with assigned corporate attorney.
• Educates internal customers on provider value-based contracts.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.
• Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration.
Required Qualifications
• At least 7 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 4 years experience in provider contract negotiations in a managed health care setting ideally negotiating different provider contract types (i.e. physician/group/hospital), or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: value-based payment (VBP), fee-for service (FFS), capitation and various forms of risk, etc.
• Strong negotiation and relationship building capabilities.
• Ability to navigate complex regulatory environments.
• Strong organizational skills and attention to detail.
• Data-driven decision-making skills, and analytical abilities.
• Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.
• Strong ability to manage multiple tasks and deadlines effectively.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
• Experience Negotiating and/or implementing Alternative Payment Methods
• Experience building or supporting reporting for Alternative Payment Methods
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V