Health Plan Provider Contracts Manager - Complex; FL Healthplan

Job Summary

Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Responsible for negotiating agreements, including value-based payment methodology, with complex provider groups that are strategically critical to plan success, including but not limited to: hospitals, independent physician associations (IPAs), and behavioral health organizations.

• Negotiate contracts and letters of agreement with the complex provider community to secure high‑quality, cost‑effective and marketable plan providers.
• Contracts/recontracts with large‑scale entities involving custom reimbursement; execute standardised alternative payment model (APM) contracts; issue escalations; support network adequacy, joint operating committees (JOCs) and delegation oversight.
• Execute, manage, and optimise value‑based contracts and enhanced provider relationship management.
• Direct analysis of financial impact of deal terms and prepare details and justification for executive approval for agreements outside of Molina approval guidelines.
• Negotiate complex provider contracts, including high‑priority physician group and facility contracts using PADU guidelines (emphasis on number or percentage of membership in value‑based relationship contracts).
• Develop and maintain provider contracts in contract management software.
• Target and recruit additional providers to reduce member access grievances.
• Engage contracted providers in renegotiation of rates and/or language; assist with cost‑control strategies that positively impact the medical cost ratio (MCR) within each region.
• Advise network contracting team members on negotiations of individual provider and routine ancillary contracts.
• Maintain contractual relationships with significant/highly visible providers.
• Evaluate provider network and implement strategic plans to meet Molina’s network adequacy standards.
• Assess contract language for compliance with corporate standards and regulatory requirements; review revised language with assigned corporate attorney.
• Participate in fee schedule determinations, including development of new reimbursement models; seek input on new reimbursement models from corporate network leadership, legal and senior level engagement as required.
• Educate internal customers on provider contracts.
• Communicate contract terms, payment structures and reimbursement rates to physicians, hospitals and ancillary providers in a clear and professional manner.
• Participate with the leadership team and other committees to address the strategic goals of the department and organization.
• Participate in contracting‑related special projects as directed.
• Provide training, mentoring and support to new and existing contracting team members.
• Up to 30% travel throughout designated regions to meet targeted needs.

• 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 (physician/group/hospital) or equivalent education/experience.
• Working familiarity with managed health care provider compensation methodologies across Medicaid and Medicare lines of business, including value‑based payment (VBP), fee‑for‑service (FFS), capitation and various forms of risk.
• Negotiation and relationship‑building capabilities.
• Ability to navigate complex regulatory environments.
• Data‑driven decision‑making skills and analytical abilities.
• Organisational skills and attention to detail.
• Ability to work cross‑functionally with internal/external stakeholders in a highly matrixed organisation.
• Ability to manage multiple tasks and deadlines effectively.
• Effective verbal and written communication skills.
• Proficiency in Microsoft Office suite and applicable software programs.

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

To all current Molina employees:
If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $73,102 - $142,549 / ANNUAL

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