Health Plan Provider Contracts Manager - Complex

Job Description

Job Summary

Essential Job Duties

• Negotiates contracts and letters of agreement with the complex provider community to secure high quality, cost-effective and marketable plan providers.
• Contracts/re-contracts with large-scale entities involving custom reimbursement; executes standardized alternative payment model (APM) contracts; issues escalations, and supports network adequacy, joint operating committees (JOCs), and delegation oversight.
• Execution, management, and optimization of value-based contracts and enhanced provider relationship management.
• Directs analysis of financial impact of deal terms and prepare details and justification for executive approval for agreements outside of Molina approval guidelines.
• In conjunction with contracting leadership, negotiates complex provider contracts including high-priority physician group and facility contracts using preferred, acceptable, discouraged, unacceptable (PADU) guidelines (emphasis on number or percentage of membership in value-based relationship contracts).
• Develops and maintains provider contracts in 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 cost ratio (MCR) within each region.
• Advises network contracting team members on negotiation of individual provider and routine ancillary contracts.
• Maintains contractual relationships with significant/highly visible providers.
• 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 corporate attorney.
• Participates in fee schedule determinations including development of new reimbursement models; seeks input on new reimbursement models from corporate network leadership, legal and senior level engagement as required.
• Educates internal customers on provider contracts.
• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.
• Participates with the leadership team and other committees to address the strategic goals of the department and organization.
• Participates in contracting-related special projects as directed.
• Provides training, mentoring and support to new and existing contracting team members.
• Travels regularly throughout designated regions to meet targeted needs.

Required Qualifications

• At least 5 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 3 years experience in provider contract negotiations in a managed health care setting ideally negotiating different provider contract types (i.e. physician/group/hospital), or equivalent combination of relevant education and experience.
• Working familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: value-based payment (VBP), fee-for service (FFS), capitation and various forms of risk, etc.
• Negotiation and relationship building capabilities.
• Ability to navigate complex regulatory environments.
• Data-driven decision-making skills, and analytical abilities.
• Organizational skills and attention to detail.
• Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.
• Ability to manage multiple tasks and deadlines effectively.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Contracting experience with integrated delivery systems, hospitals and groups (specialty and ancillary).
• Experience with Medicaid, Medicare, and Marketplace government-sponsored programs.

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.

Pay Range

$69,447 - $142,548 / ANNUAL

Benefits

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

07/07/2026

Job Alerts

Sign up to receive automatic notices when jobs that match your interests are posted.