Health Plan Provider Contracts Manager - Complex (FL Healthplan)

Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance.

Requirements

• Negotiates contracts and letters of agreement with the complex provider community
• Contracts/re-contracts with large-scale entities involving custom reimbursement
• Executes standardized alternative payment model (APM) contracts
• Supports network adequacy, joint operating committees (JOCs), and delegation oversight
• Develops and maintains provider contracts in contract management software
• Targets and recruits additional providers to reduce member access grievances
• Engages targeted contracted providers in renegotiation of rates and/or language
• Advises network contracting team members on negotiation of individual provider and routine ancillary contracts
• Maintains contractual relationships with significant/highly visible providers
• 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
• Participates in fee schedule determinations including development of new reimbursement models
• Educates internal customers on provider contracts
• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers
• Participates with the leadership team and other committees to address the strategic goals of the department and organization
• Participates in contracting-related special projects as directed
• Provides training, mentoring and support to new and existing contracting team members

Benefits

• Competitive benefits and compensation package