[Hiring] Director, Health Plan Provider Relations @Molina Healthcare

Role Description

Leads and directs team responsible for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. Collaborates with network leadership and the corporate network team to develop and implement standardized provider relationship management and provider services for the health plan.

• Oversees the plan’s provider relations function and team members.
• Responsible for the daily operations of the department, including leading and supporting various provider relations activities.
• Develops health plan-specific provider relations strategies.
• Collaborates with health plan network management and operations teams.
• Develops and deploys strategic network planning tools.
• Provides matrix team support including new markets provider/contract support services.
• Builds and/or facilitates provider communication, training and education programs.
• Ensures compliance with applicable company/plan business requirements.
• Oversees and leads provider representatives activities.
• Assists with ongoing provider network development and education.
• Develops and implements tracking tools for issue resolution.
• Oversees appropriate and timely interventions/communications when providers have issues or complaints.
• Serves as a resource to support the plan’s initiatives.
• Ensures appropriate cross-departmental communication of provider relations initiatives.
• Designs and implements programs to build and nurture positive relationships.
• Develops and implements strategies to increase provider engagement in HEDIS and quality initiatives.
• Engages contracted network providers regarding cost control initiatives.
• Develops and implements strategies to reduce member access grievances.
• Oversees the integrated health home (IHH) program.
• Hires, trains, manages and evaluates team member performance.

Qualifications

• At least 8 years of provider services experience.
• At least 3 years of management/leadership experience.
• Strong understanding of the health care delivery system.
• Experience with various managed health care provider compensation methodologies.
• Previous experience with community agencies and providers.
• Strong organizational skills and attention to detail.
• Ability to manage multiple tasks and deadlines effectively.
• Experience with preparing and presenting formal presentations.
• Strong interpersonal skills.
• Ability to work in a cross-functional highly matrixed organization.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Contract negotiation experience.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.