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Company: Molina Healthcare
Location: San Diego, CA
Career Level: Director
Industries: Healthcare, Pharmaceutical, Biotech

Description



Summary

Bring your Medical & Medicare contracting management experience to our California health plan. Lead the contracting group handling San Diego, Imperial Valley & Sacramento areas.

What you will do:
Plan, organize, staff, and coordinate the Provider Contracts activities for the state health plan. Work with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.
• Monitor and report network adequacy for Medicare and Medicaid services.
• In conjunction with direct management and senior leadership, oversee 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.
• Advise 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.
• Utilize standardized contract templates and Pay for Performance strategies.
• Develop and maintain Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversee the development of new reimbursement models in concert with direct management and senior leadership/management.
• Communicate 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.
• Participate on the management team and other committees addressing the strategic goals of the department and organization.
• Oversee 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.
• Manage the relationship with area agencies and community provider partners to support and advance Plan initiatives.
• Develop and implement strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.



Qualifications

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

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.

#CB-MHI


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