Marketplace Contracting Program Director (Western Region - PST Time Zone) - REMOTE - Military Veterans
at Molina Healthcare
Job Description
Job Summary
The Program Director, Marketplace Contracting is responsible for managing the Marketplace provider contracting process for the assigned regions. Leads the Marketplaces provider strategy, while developing and maintaining strong and consistent relationships with assigned health plan markets.
This role manages key provider relationships through health plan partners (Plan Presidents, local contract leader, etc.) and demonstrate comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. Co-create and/or oversee the development and management of Molinas internal Marketplace rate approval process that meets internal operational standards.
Essential Job Duties
Assist the health plans with interpreting eligibility and reimbursement queries as well as relevant data requests
Routinely communicate organizational policies, procedures, processes, regulatory updates, anticipate and respond to Provider/health plan educational needs and conduct Provider/health plan trainings
Understand Marketplaces contracting system(s) to draft, monitor, and maintain the provider contracting departments SOPs, policies, job aides, and function as a SME to support the training of designated users on how to load, update, maintain, and pull reports from the contracting database(s)
Industry experience and knowledge of industry standard fee schedules and timing of standard fee schedule updates
Manages strategic positioning for Marketplace provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements
Identify and manages initiatives that improve medical cost and quality
Maintain a professional and courteous demeanor in all interactions with customers and internal stakeholders while driving structure and organization
May engage and oversee the work of external vendors
Job Qualifications
REQUIRED EDUCATION:
Bachelor's Degree or equivalent combination of education and work experience.
REQUIRED EXPERIENCE:
7-9 years of healthcare provider contracting and strategy experience, and a strong understanding of healthcare industry regulations
Experience with contract management software and negotiation techniques
PREFERRED EDUCATION:
Graduate Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
10+ years
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
CPHQ
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: $79,607.91 - $172,483.8 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
USA
Molina believes every person, family and community deserves access to high-quality health care regardless of their situation. Our mission is to deliver effective, reliable and affordable health care to those who need it most. We strive to meet the physical, social and emotional needs of each member and to strengthen the communities we serve.
We do this by offering a holistic, community-based approach designed specifically to meet the individual needs of our members.
What started in 1980 as one clinic in Long Beach, aimed at addressing the disparities in access to quality health care, has grown into 19 health plans across the country. For over 40-years we’ve been improving the lives of our 5.1 million members across the country by pioneering health care services exclusively for those with government-sponsored health care.
As our membership has grown over the years, so has our commitment to the communities we serve. In 2020, we launched the MolinaCares Accord, which makes substantial investments to improve members’ access to health care.