Manager, Health Plan Provider Contracts (Value-Based Contracts)

About the role

Molina Health Plan Provider Network Contracting roles are responsible for the value-based payments (VBP) network strategy and development with respect to financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan, and in compliance with all relevant federal, state, and local regulations. The position focuses on contracting and re-contracting complex agreements with Alternative Payment Methods, including Value-Based and Capitated payments for Hospitals, Independent Practice Associations, and complex Behavioral Health arrangements. Responsibilities include managing VBPs through negotiation, implementation, and ongoing management, as well as maintaining critical provider information in claims and provider databases.

Responsibilities

• Oversee the plan’s provider value-based contracting function; collaborate with other operational departments and functional business unit stakeholders on various provider value-based contracting activities.
• Negotiate contracts with the complex provider community to ensure high-quality, cost-effective, and marketable providers.
• Execute standardized alternative payment model (APM) or value-based payment (VBP) contracts.
• Issue escalations and support joint operating committees (JOCs) and delegation oversight.
• Develop health plan-specific provider value-based contracting strategies and assist in identifying VBP provider targets to meet Molina goals.
• Achieve annual savings through recontracting initiatives; implement cost-control initiatives to positively influence the medical cost ratio (MCR) in each contracted region.
• Prepare provider contracts in concert with established company guidelines for physicians, hospitals, managed long-term services and supports (MLTSS), and other healthcare providers.
• Utilize established reimbursement tolerance parameters (across multiple specialties/geographies) and oversee the development of new reimbursement models.
• Ensure compliance with applicable provider value-based contracting requirements; produce and monitor recurring reports to track and ensure compliance with state requirements.
• Develop and implement strategies to minimize the company’s financial exposure; monitor and adjust strategy implementation as needed.
• Assess contract language for compliance with corporate standards and regulatory requirements; review revised language with assigned corporate attorney.
• Educate internal customers on provider value-based contracts.
• Participate in management teams and committees addressing the strategic goals of the department and organization.
• Hire, train, manage, and evaluate team member performance; provide coaching, development, and recognition; ensure ongoing staff training, hold regular team meetings, and drive communication and collaboration.

Requirements

• At least 7 years of experience in network contracting with large specialty or multispecialty provider groups.
• At least 4 years of experience in provider contract negotiations in a managed healthcare setting, ideally negotiating different provider contract types (e.g., physician/group/hospital).
• At least 1 year of management/leadership experience.
• Experience with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including value-based payment (VBP), fee-for-service (FFS), capitation, and various forms of risk.
• Strong negotiation and relationship-building capabilities.
• Ability to navigate complex regulatory environments.
• Strong organizational skills and attention to detail.
• Data-driven decision-making skills and analytical abilities.
• Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.
• Strong ability to manage multiple tasks and deadlines effectively.
• Strong verbal and written communication skills.
• Proficiency in Microsoft Office suite and applicable software programs.

Preferred Qualifications

• Experience negotiating and/or implementing Alternative Payment Methods.
• Experience building or supporting reporting for Alternative Payment Methods.

Pay

Pay Range: $72,370 - $156,803 per year. Actual compensation may vary based on geographic location, work experience, education, and/or skill level.