Manager, Provider Contracts
Molina Healthcare Everett, Washington; Albany, New York; Seattle, Washington; New York, New York; Buffalo, New York; New York; Cleveland, Ohio; Houston, Texas; Salt Lake City, Utah; Orlando, Florida; Florida; Tampa, Florida; Augusta, Georgia; Cedar Rapids, Iowa; Nampa, Idaho; Lexington-Fayette, Kentucky; Las Cruces, New Mexico; Santa Fe, New Mexico; Syracuse, New York; Texas; Provo, Utah; Racine, Wisconsin; Chandler, Arizona; Kentucky; Nebraska; Roswell, New Mexico; Washington; Kenosha, Wisconsin; Davenport, Iowa; Idaho Falls, Idaho; Meridian, Idaho; Covington, Kentucky; Bellevue, Nebraska; Omaha, Nebraska; Columbus, Ohio; Madison, Wisconsin; Wisconsin; Tucson, Arizona; Macon, Georgia; Atlanta, Georgia; Savannah, Georgia; Iowa City, Iowa; Caldwell, Idaho; Louisville, Kentucky; Detroit, Michigan; Michigan; Grand Island, Nebraska; Yonkers, New York; Akron, Ohio; Utah; Scottsdale, Arizona; Columbus, Georgia; Idaho; Owensboro, Kentucky; Sterling Heights, Michigan; Kearney, Nebraska; Ohio; Dayton, Ohio; San Antonio, Texas; Austin, Texas; West Valley City, Utah; Layton, Utah; Orem, Utah; Vancouver, Washington; Tacoma, Washington; Green Bay, Wisconsin; Milwaukee, Wisconsin; Mesa, Arizona; Jacksonville, Florida; Des Moines, Iowa; Sioux City, Iowa; Bowling Green, Kentucky; Ann Arbor, Michigan; Rochester, New York; Cincinnati, Ohio; Fort Worth, Texas; Spokane, Washington; Phoenix, Arizona; St. Petersburg, Florida; Miami, Florida; Georgia; Iowa; Lincoln, Nebraska; Albuquerque, New Mexico; New Mexico; Rio Rancho, New Mexico; Dallas, Texas; Bellevue, Washington; Boise, Idaho; Warren, Michigan; Grand Rapids, Michigan Job ID 2030336***Remote and must live in the United States***
Job Description
Job Summary
Molina National Level Contracting jobs are responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate 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.
Knowledge/Skills/Abilities
• In conjunction with the Director, Provider Contracts, develops health plan-specific provider contracting strategies, identifying 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 the Plan's patients or members.
• Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, MLTSS and other health care providers.
• Assists in achieving annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
• Utilizes standardized contract templates and Pay for Performance strategies.
• Utilizes established Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with Director.
• Oversees the maintenance of all Provider and payer Contract Templates. Works with legal and Corporate Network Management on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines. Produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
• Develops and implements strategies to minimize the company's financial exposure. Monitors and adjusts strategy implementation as needed to achieve desire goals and reduce minimize the company's financial exposure..
Job Qualifications
Required Education
Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience
Required Experience
5-7 years
Preferred Education
Graduate degree
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.
#PJCore
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 02/27/2025ABOUT OUR LOCATION
View Map- Sr Engineer, Applications Albany New York, Everett Washington, Nebraska, Utah, Michigan, Wisconsin, Iowa, Texas, New York, Kentucky, Georgia, Washington, Florida, New Mexico, Idaho, Ohio, Rochester New York, Bellevue Nebraska, Chandler Arizona, Mesa Arizona, Roswell New Mexico, Layton Utah, Iowa City Iowa, Cleveland Ohio, Caldwell Idaho, Boise Idaho, Albuquerque New Mexico, Sterling Heights Michigan, Miami Florida, Lincoln Nebraska, Grand Island Nebraska, Dayton Ohio, Columbus Ohio, Green Bay Wisconsin, Kenosha Wisconsin, Meridian Idaho, Scottsdale Arizona, Fort Worth Texas, Spokane Washington, Buffalo New York, Covington Kentucky, Owensboro Kentucky, Davenport Iowa, Savannah Georgia, Macon Georgia, Milwaukee Wisconsin, Idaho Falls Idaho, Rio Rancho New Mexico, Warren Michigan, Tacoma Washington, Seattle Washington, Jacksonville Florida, Bowling Green Kentucky, Kearney Nebraska, Akron Ohio, Cincinnati Ohio, Tucson Arizona, San Antonio Texas, Orem Utah, Provo Utah, Ann Arbor Michigan, Orlando Florida, New York New York, Omaha Nebraska, Columbus Georgia, Dallas Texas, Houston Texas, Bellevue Washington, Vancouver Washington, Tampa Florida, Syracuse New York, Yonkers New York, Lexington-Fayette Kentucky, Louisville Kentucky, Sioux City Iowa, Atlanta Georgia, Racine Wisconsin, Madison Wisconsin, Nampa Idaho, Phoenix Arizona, Las Cruces New Mexico, West Valley City Utah, St. Petersburg Florida, Des Moines Iowa, Cedar Rapids Iowa, Augusta Georgia, Santa Fe New Mexico, Austin Texas, Salt Lake City Utah, Grand Rapids Michigan, Detroit Michigan 04/11/2025
- Specialist, Pharmacy Ops Albany New York, Everett Washington, Utah, Florida, Idaho, Wisconsin, Texas, Georgia, Michigan, New Mexico, Kentucky, Iowa, Nebraska, New York, Washington, Ohio, Orem Utah, Vancouver Washington, Spokane Washington, New York New York, Cincinnati Ohio, Savannah Georgia, Madison Wisconsin, Phoenix Arizona, Chandler Arizona, Rio Rancho New Mexico, Covington Kentucky, Lincoln Nebraska, Grand Island Nebraska, Provo Utah, Nampa Idaho, Houston Texas, Des Moines Iowa, Akron Ohio, Bellevue Washington, Tacoma Washington, Seattle Washington, Syracuse New York, Buffalo New York, Augusta Georgia, Caldwell Idaho, Tucson Arizona, Fort Worth Texas, Dayton Ohio, Cleveland Ohio, West Valley City Utah, Grand Rapids Michigan, Sterling Heights Michigan, Rochester New York, Racine Wisconsin, Milwaukee Wisconsin, Boise Idaho, Meridian Idaho, Austin Texas, Owensboro Kentucky, Louisville Kentucky, Omaha Nebraska, Layton Utah, Jacksonville Florida, Orlando Florida, Columbus Ohio, Kenosha Wisconsin, Idaho Falls Idaho, Albuquerque New Mexico, Las Cruces New Mexico, Kearney Nebraska, Iowa City Iowa, Roswell New Mexico, Ann Arbor Michigan, Yonkers New York, Columbus Georgia, Mesa Arizona, Dallas Texas, Bowling Green Kentucky, Bellevue Nebraska, Sioux City Iowa, Davenport Iowa, Cedar Rapids Iowa, Salt Lake City Utah, Detroit Michigan, Tampa Florida, Miami Florida, Macon Georgia, Green Bay Wisconsin, Scottsdale Arizona, Warren Michigan, St. Petersburg Florida, Atlanta Georgia, San Antonio Texas, Santa Fe New Mexico, Lexington-Fayette Kentucky 04/11/2025
- Care Review Clinician, Inpatient Review (RN) Everett Washington, Albany New York, Iowa, Texas, Nebraska, Ohio, Michigan, Washington, Wisconsin, Georgia, Kentucky, Idaho, New Mexico, Florida, Utah, New York, Nampa Idaho, Dallas Texas, Albuquerque New Mexico, Bellevue Washington, Tampa Florida, Owensboro Kentucky, Bowling Green Kentucky, Milwaukee Wisconsin, Meridian Idaho, Mesa Arizona, Las Cruces New Mexico, Salt Lake City Utah, St. Petersburg Florida, Yonkers New York, Bellevue Nebraska, Des Moines Iowa, Augusta Georgia, Caldwell Idaho, Idaho Falls Idaho, Layton Utah, Ann Arbor Michigan, Warren Michigan, Tacoma Washington, Jacksonville Florida, Orlando Florida, Buffalo New York, Lexington-Fayette Kentucky, Cleveland Ohio, Savannah Georgia, Chandler Arizona, Santa Fe New Mexico, West Valley City Utah, Orem Utah, Dayton Ohio, Macon Georgia, Green Bay Wisconsin, Tucson Arizona, Grand Rapids Michigan, Sterling Heights Michigan, Seattle Washington, Covington Kentucky, Miami Florida, Syracuse New York, New York New York, Omaha Nebraska, Grand Island Nebraska, Akron Ohio, Columbus Ohio, Racine Wisconsin, Scottsdale Arizona, Fort Worth Texas, Vancouver Washington, Sioux City Iowa, Cedar Rapids Iowa, Columbus Georgia, Atlanta Georgia, Madison Wisconsin, Phoenix Arizona, Austin Texas, Rio Rancho New Mexico, Roswell New Mexico, Spokane Washington, Rochester New York, Lincoln Nebraska, Davenport Iowa, San Antonio Texas, Houston Texas, Provo Utah, Detroit Michigan, Louisville Kentucky, Kearney Nebraska, Iowa City Iowa, Cincinnati Ohio, Kenosha Wisconsin, Boise Idaho 04/09/2025
- Rep, Customer Experience (Part Time, Bilingual preferred) Doral Florida, Washington, Nebraska, New Mexico, Miami Florida, Kissimmee Florida, Jacksonville Florida, East Naples Florida, Florida, Idaho, Michigan, Kentucky, Wisconsin, Ohio, Iowa, Arizona, Utah, Georgia, New York, Texas 04/08/2025