National Contracting Director (Dental)

Molina Healthcare•Long Beach, CA

14h

About The Position

JOB DESCRIPTION Job Summary Provides deep subject matter expertise and leadership for national dental vendor contracting activities across the Molina enterprise. Supports health plan dental strategies through the development, negotiation, and ongoing management of national dental vendor contracts, amendments, and riders supporting dental solutions and programs aligned with health plan initiatives. Essential Job Duties Leads negotiation of national dental vendor agreements, amendments, and financial arrangements including CAP structures, SLAs, and performance guarantees. Partners with health plans, finance, legal, compliance, and operations to ensure contracts support regulatory, operational, and financial objectives. 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. Contributes as a key member of the department’s leadership team and participates in committees to address department and organizational strategic goals. 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. Collaborates with assigned national vendors to improve contractual terms and maintain positive relationships. Provides national contracts support for other Molina departments/functions, including: 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. Provides training and guidance as needed to contracting staff. Helps develop and utilize standardized contract templates and pay-for-performance (P4P)/value-based payment (VBP) strategies. Utilizes sound reporting and analytical tools to develop and refine strategic work plans.

Requirements

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.
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.
Strong negotiation and relationship building capabilities.
Ability to navigate complex regulatory environments.
Organizational skills and attention to detail.
Strong data-driven decision-making skills, and analytical abilities.
Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.
Strong ability to manage multiple tasks and deadlines effectively.
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Nice To Haves

Experience contracting with hospitals, physician groups, high-volume specialists and ancillary providers.
Experience negotiating alternative payment models (APMs).
Deep experience with Medicaid, Medicare, and Marketplace government-sponsored programs.
Management/leadership experience.

Responsibilities

Leads negotiation of national dental vendor agreements, amendments, and financial arrangements including CAP structures, SLAs, and performance guarantees.
Partners with health plans, finance, legal, compliance, and operations to ensure contracts support regulatory, operational, and financial objectives.
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.
Contributes as a key member of the department’s leadership team and participates in committees to address department and organizational strategic goals.
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.
Collaborates with assigned national vendors to improve contractual terms and maintain positive relationships.
Provides national contracts support for other Molina departments/functions, including: 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.
Provides training and guidance as needed to contracting staff.
Helps develop and utilize standardized contract templates and pay-for-performance (P4P)/value-based payment (VBP) strategies.
Utilizes sound reporting and analytical tools to develop and refine strategic work plans.