Search for More Jobs

Similar Jobs

CA Pharmacy Manager

CVS Health San Diego, CA

EFMP Case Liaison

Armed Forces Services Corporation San Diego, CA

Sales and Marketing Director

Otay Ranch Chula Vista, CA
Get alerts for jobs like this Get jobs like this tweeted to you
Company: Molina Healthcare
Location: San Diego, CA
Career Level: Director
Industries: Healthcare, Pharmaceutical, Biotech



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.


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.


 Apply on company website