Provider Contract Manager
Location: Bothell, Washington
Description: Molina Healthcare is in need of Provider Contract Manager right now, this occupation will be assigned in Washington. For complete informations about this occupation opportunity please give attention to these descriptions. MOLINA HEALTHCARE - PROVIDER CONTRACT MANAGER
JOB SUMMARY
Negotiates agreements with integrated delivery systems, hospitals and physician groups that res! ult in high quality, cost effective and marketable providers.
ESSENTIAL FUNCTIONS
Duties and Responsibilities
- Negotiates physician group, ancillary and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
- Develops and maintains provider contracts in EMPTORIS contract management software.
- Targets and recruits 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 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 ad! equacy standards.
- Assesses contract language for comp! liance with Corporate standards and regulatory requirements and reviews 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 Hea! lth 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
- Other duties as assigned.
Required Education:
Bachelor’s Degree in a healthcare related field or equivalent experience.
Required Experience:
3 years experience in Managed Care (including Medicaid, Medicare/Medicare Advantage and other State governed plans).
3 years experience in contract negotiations.
To all current Molina employees if you are interested in applying for this position please fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online. Be sure to let us know you are a current employee by selecting “Molina Employee (current) in the source section of the online appli! cation.
Molina Healthcare offers competitive benefits and comp! ensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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If you were eligible to this occupation, please deliver us your resume, with salary requirements and a resume to Molina Healthcare.
Interested on this occupation, just click on the Apply button, you will be redirected to the official website
This occupation will be opened on: Tue, 02 Apr 2013 04:18:47 GMT
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