Job Description
JOB DESCRIPTION Employee for this role must reside in Florida Job Summary Leads and manages team responsible for Hospital Health Plan provider network contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Responsible for negotiating complex contracts that are strategically critical to plan success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements. Essential Job Duties 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; includes identifying 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 the plan's members, in addition to identifying 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. Prep