Provider Contracts Manager II
Location: Troy Mic! higan
Description: Molina Healthcare is presently looking of Provider Contracts Manager II right now, this vacancy will be placed in Michigan. For detail informations about this vacancy opportunity please give attention to these descriptions. Job Summary
Negotiates agreements with highly visible providers who are strategic to the success of the Plan, including, integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.
Essential Functions
- Negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
- Develops and maintains provider contracts in EMPTORIS contract management software.
- Targets and recru! its 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.
- Complies with required workplace safety standards.
- Knowledge of managed care culture and philosophy
- Strong analytical and reasoning abilities
- Excellent presentation and verbal and written communication skills
- Ability to abide by Molina's policies
- Ability to maintain attendance to support required quality and quantity of work
- Maintains confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and fraud and abuse prevention detection policies and procedures
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Bachelor's Degree in a healthcare related field or an equivalent combination of education and! experience.
Required Experience:
5 years experienc! e in Managed Care (including Medicaid, Medicare/Medicare Advantage and other State governed plans).
3 years experience in contract negotiations.
Required Licensure/Certification:
None required
Preferred Education:
Bachelor's Degree with Master's Degree
Preferred Experience:
5 - 10+ years of experience negotiating highly visible, strategic provider agreements.
Preferred Licensure/Certification:
State specific job description:
- Manage contracting requirements with specific list of assigned hospitals. This includes all amendments, clarifications, Molina product additions, hospital program additions, hospital-employed physicians. Interact with Provider Services Department to assure contract performance and continued relationship.
- Lead specific network development/improvement projects, including project plans, staff coordination, and cross-departmental needs.
- ! Engage and interact with Provider Contract Specialists to enhance team success and efficient utilization of resources.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Molina Healthcare.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Fri, 21 Feb 2014 18:39:37 GMT
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