Legal Contract Manager - Albany, NY, United States - Molina Healthcare

Description

Remote and must live in New York*** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, 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.

This role negotiates contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers.

Contract/Re-contracting with large scale entities involving custom reimbursement. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight. Tighter knit proximity ongoing after contract.

• In conjunction with Director/Manager, Provider Contracts, negotiates Complex Provider contracts including but not limited to high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines. Develops and maintains provider contracts in contract management software.
• 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.
• Advises Network Provider Contract 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 adequacy standards.
• Assesses contract language for compliance with Corporate standards and regulatory requirements and review 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, legal and VP level engagement as required.
• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.
• Participates with the management team and other committees addressing the strategic goals of the department and organization.
• Participates in other contracting related special projects as directed.

Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience.

5-7 years contract-related experience in the health care field including, but not limited to, provider's office, managed care organization, or other health care environment.

• 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, group and hospital contracting, etc.
• Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee-for service, capitation and various forms of risk, ASO, etc.

Master's Degree in a related field or an equivalent combination of education and experience
3+ years in Provider Network contracting

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.