National Ancillary Contracting Director

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    "ExternalDescriptionStr": "<p>&nbsp;</p>\n<p><i><strong><u>***Remote and must live in the United States***</u></strong></i></p>\n<p>JOB DESCRIPTION&nbsp;</p>\n<p>Job Summary</p>\n<p>Provides deep subject matter expertise and leadership for national ancillary contracting activities across the Molina enterprise. &nbsp;Supports network strategy and development with respect to adequacy, financial performance, and operational performance. &nbsp;Develops contracting standards and resources designed to enable Molina to establish and maintain distinct high-performing networks of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values. &nbsp;Responsible for negotiating complex national agreements with highly visible providers including integrated delivery systems, hospitals and physician groups.</p>\n<p>&nbsp;</p>\n<p><strong>Essential Job Duties</strong></p>\n<p>•&nbsp;Oversees the development and implementation of the ancillary provider network and contract strategies; identifies specialties and geographic locations to concentrate resources for the purpose of establishing a sufficient network of participating providers to serve the health care needs of Molina membership.<br>\n  •&nbsp;Develops and maintains a standard provider reimbursement strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); obtains input from corporate, legal and other stakeholders regarding new reimbursement models and oversees development accordingly.<br>\n  •&nbsp;Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the enterprise contract management system.<br>\n  •&nbsp;Directs the preparation of provider contracts and oversees negotiation of contracts in alignment with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers.<br>\n  •&nbsp;Contributes as a key member of the department’s leadership team and participates in committees to address department and organizational strategic goals.<br>\n  •&nbsp;Oversees the maintenance of all provider contract information and provider contract templates and ensures that contracts can be configured within the QNXT system; collaborates with legal, corporate and other stakeholders as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.<br>\n  •&nbsp;Monitors and reports network adequacy for Medicare and Medicaid services.&nbsp;<br>\n  •&nbsp;Develops strategies to improve EDI/MASS rates.<br>\n  • Educates and works with assigned state health plans on any corporate changes or initiatives as necessary.<br>\n  • Collaborates with assigned national vendors to improve contractual terms and maintain positive relationships.&nbsp;<br>\n  •&nbsp;Provides national contracts support for other Molina departments/functions, including: &nbsp;provider services (and activities with provider association(s) and joint operating committee (JOC) leadership); delegation oversight; provider network administration (provider information management and business analyses of national contracts/benefits to support accurate configuration for claims payment); provider/member inquiry research and resolution; and provider/member appeals and grievances.<br>\n  •&nbsp;Coordinates with corporate and business development teams to ensure that Molina grows faster (profitable growth) than competitors in target new markets and expansion opportunities.<br>\n  •&nbsp;Provides training and guidance as needed to contracting staff.&nbsp;<br>\n  •&nbsp;Helps develop and utilize standardized contract templates and pay-for-performance (P4P) (P4P) strategies.<br>\n  •&nbsp;Utilizes sound reporting and analytical tools to develop and refine strategic work plans.<br>\n  • Provides training, mentoring and support to new and existing contracting team members.<br>\n  &nbsp;</p>\n<p><strong>Required Qualifications</strong></p>\n<p>• At least 8 years of experience in provider network management/provider contracting, specifically in value-based payment (VBP) reimbursement, or equivalent combination of relevant education and experience.&nbsp;<br>\n  • Experience 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.<br>\n  • Strong negotiation and relationship building capabilities.<br>\n  • Ability to navigate complex regulatory environments.<br>\n  • Organizational skills and attention to detail.<br>\n  • Strong data-driven decision-making skills, and analytical abilities.<br>\n  • Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.<br>\n  • Strong ability to manage multiple tasks and deadlines effectively.<br>\n  • Strong verbal and written communication skills. &nbsp;<br>\n  • Microsoft Office suite and applicable software programs proficiency.<br>\n  &nbsp;</p>\n<p><strong>Preferred Qualifications</strong></p>\n<p>• Experience contracting with hospitals, physician groups, high-volume specialists and ancillary providers.<br>\n  • Experience negotiating alternative payment models (APMs).<br>\n  • Deep experience with Medicaid, Medicare, and Marketplace government-sponsored programs.<br>\n  • Management/leadership experience.<br>\n  &nbsp;</p>\n<p>&nbsp;</p>\n<p>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.<br><br>\n  Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p>",
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