Manager, Hospital Health Plan Provider Contracts; Florida

Job Summary

Leads and manages a team responsible for Hospital Health Plan provider network contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Responsibilities include negotiating complex contracts that are strategically critical to plan success, including alternative payment models (APMs), value‑based payment (VBP) contracts, capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements.

• Oversees the plan’s Hospital provider contracting function; collaborates with other operational departments and functional business unit stakeholders on various provider contracting activities.
• Negotiates contracts with the complex provider community that result in high‑quality, cost‑effective, and marketable providers.
• Contracts/re‑contracts with large‑scale entities involving custom reimbursement.
• Executes standardized alternative payment model (APM) or value‑based payment (VBP) contracts.
• Issues escalations and supports network adequacy, joint operating committees (JOCs), and delegation oversight.
• In conjunction with contracting leadership, develops health‑plan‑specific provider contracting strategies including VBP; identifies specialties and geographic locations to concentrate resources for establishing a sufficient network of participating providers to serve the plan’s members, and identifies VBP provider targets to meet Molina goals.
• Assists in achieving annual savings through recontracting initiatives; implements cost‑control initiatives to positively influence the medical cost ratio (MCR) in each contracted region.
• Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, managed long‑term services and supports (MLTSS) and other health care providers.
• Utilizes established reimbursement tolerance parameters (across multiple specialties/geographies) and oversees the development of new reimbursement models.
• Oversees the maintenance of all provider and payer contract templates; collaborates with legal and corporate network management on an as‑needed basis to modify templates to ensure compliance with all contractual and/or regulatory requirements.
• Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines; produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
• Develops and implements strategies to minimize the company’s financial exposure; monitors and adjusts strategy implementation as needed to achieve desired goals and reduce financial exposure.
• Advises network provider contract specialists on negotiation of individual provider and routine ancillary contracts.
• Evaluates provider network and implements strategic plans with the goal of meeting Molina’s network adequacy standards.
• Assesses contract language for compliance with corporate standards and regulatory requirements and reviews 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 management, legal and senior level engagement as required.
• Educates internal customers on provider contracts.
• Participates on the management team and other committees addressing the strategic goals of the department and organization.
• Hires, trains, manages and evaluates team member performance—provides coaching, development, and recognition; ensures ongoing staff training, holds regular team meetings, and drives communication and collaboration.

• At least 7 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 4 years experience in provider contract negotiations in a managed health care setting—ideally negotiating different provider contract types (e.g., physician/group/hospital), or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Experience with various managed health care…