Director, Provider Contracts / Dental Market Segment - REMOTE - Military Veterans
at Molina Healthcare
KNOWLEDGE/SKILLS/ABILITIES
Plans, organizes, staffs, and coordinates the Provider Contracts activities for contracts at a National Level. 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 in Dental market segment.
Experience leading Provider Contract, Provider Data Management, and Provider Relations teams.
Dental Provider Contract experience.
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: $87,568.7 - $189,732.18 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Bowling Green, KY
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.