Job Description
Job Summary
Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. Plans, organizes, staffs, and coordinates the Provider Services activities for the state health plan. Works with direct management, senior leadership/management, corporate, and staff to develop and implement standardized provider servicing and relationship strategies.
Job Duties
Manages the Plan’s Provider Relations functions including managers and team members. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Services functions with an emphasis on education, outreach and resolving provider inquiries.
• Responsible for providing and developing standards and resources to help the Molina health plan successfully develop and refine cost effective and high-quality strategic provider networks, establishing both internal and external long-term partnerships.
• Works collaboratively with health plan network management and operations teams and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives with an emphasis on developing and implementing standards, resources, tools and best practices sharing across the organization.
• Develops and deploys strategic network planning tools to drive provider services and contracting strategy across the organization. Facilitates planning and documentation of network management standards and processes for all line of business.
• Provides matrix team support including but not limited to: New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services.
• Builds and/or performs provider communication, training & education programs for internal staff, external providers, and other stakeholders.
• Ensures compliance with applicable company/plan business requirements including state/federal statutes, government sponsored program requirements, and network access standards.
Job Qualifications
REQUIRED EDUCATION:
• Bachelor's Degree or commensurate/equivalent experience in provider services or contract network development and management in a managed healthcare setting.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 7+ years' experience servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products.
• 7+ years' experience in managed healthcare administration.
• Experience demonstrating working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicare or Medicaid lines of business, including but not limited to fee-for service, capitation and delegation models, and various forms of risk, ASO, agreements, etc.
• Experience with preparing and presenting formal presentations.
• 2+ years in a direct or matrix leadership position.
• Min. 2 years' experience managing/supervising employees.
PREFERRED EDUCATION:
Master’s Degree in Health or Business related field.
PREFERRED EXPERIENCE:
• 7+ years managed healthcare administration experience.
• Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals).
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.