At Shire, we are proud and grateful to employ military veterans and thank them for their contributions to our company and our country. See where your military experience can play a role at Shire by using our military skills translator job search tool below:
Job Summary
This Program Director is responsible for managing the Marketplace provider contracting process for Molina Healthcare in the Western regions (ie. CA, WA, NV, AZ). The Marketplace Program Director leads the Marketplace’s provider strategy, while developing and maintaining strong and consistent relationships with assigned health plan markets.
This role manages key provider relationships through health plan partners (Plan Presidents, local contract leader, etc) and demonstrate comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. Co-create and/or oversee the development and management of Molina’s internal Marketplace rate approval process that meets internal operational standards.
KNOWLEDGE/SKILLS/ABILITIES
Assist the health plans with interpreting eligibility and reimbursement queries as well as relevant data requests
Routinely communicate organizational policies, procedures, processes, regulatory updates, anticipate and respond to Provider/health plan educational needs and conduct Provider/health plan trainings
Understand Marketplace’s contracting system(s) to draft, monitor, and maintain the provider contracting department’s SOPs, policies, job aides, and act as a SME to support the training of designated users on how to load, update, maintain, and pull reports from the contracting database(s)
Industry experience and knowledge of industry standard fee schedules and timing of standard fee schedule updates
Manages strategic positioning for Marketplace provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements
Identify and manages initiatives that improve medical cost and quality
Maintain a professional and courteous demeanor in all interactions with customers and internal stakeholders while driving structure and organization
May engage and oversee the work of external vendors
JOB QUALIFICATIONS
Required Education
Bachelor's degree or equivalent combination of education and experience
Required Experience
7-9 years of healthcare provider contracting and strategy experience, and a strong understanding of healthcare industry regulations
Experience with contract management software and negotiation techniques
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
10+ years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCorp
#LI-AC1
Pay Range: $72,370.82 - $156,803.45 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.