[Hiring] Manager, National Dental Provider Services @Molina Healthcare

Role Description

Leads and manages team responsible for enterprise Dental network management and operations activities including 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.

• Oversees national Dental network management and operations function and team.
• Responsible for the daily operations of the department, including leading and supporting various enterprise-wide provider services activities including education, outreach and resolving provider inquiries.
• Develops and deploys strategic Dental network planning tools to drive provider services and contracting strategy across the enterprise.
• Facilitates strategic planning and documentation of Dental network management standards and processes.
• Develops standards and resources to help Molina health plans successfully develop and refine cost-effective and high-quality strategic provider networks, establishing both internal and external long-term partnerships.
• Collaborates with health plan network leadership and operations teams and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives.
• Oversees national network management and operations provider contracting strategies.
• Oversees and leads the functions of the external provider representatives.
• Assists with ongoing enterprise-wide provider network development and the education of contracted network providers.
• Develops and implements tracking tools to ensure timely issue resolution and compliance with all network-related standards.
• Oversees appropriate and timely intervention/communication when providers have issues or complaints.
• Serves as a resource to support health plan initiatives and help ensure regulatory requirements and strategic goals are realized.
• Ensures appropriate cross-departmental communication of provider network initiatives and contracted network provider issues.
• Designs and implements enterprise-wide programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and health plans.
• Develops and implements enterprise-wide strategies to increase provider engagement in Healthcare Effectiveness Data Information Set (HEDIS) and quality initiatives.
• Provides matrixed team support including: new markets provider/contract support services, resolution support, and national contract management support services.
• Builds, drafts and/or performs provider communications, training and education programs for internal staff, external providers, and other stakeholders.
• Develops and implements strategies to reduce member access grievances with contracted enterprise providers.
• Engages enterprise-wide contracted network providers regarding cost-control initiatives, medical cost ratio (MCR), non-emergent utilization, and Consumer Assessment of Healthcare Providers and Systems (CAHPS).
• Ensures compliance with applicable company/plan business requirements including state/federal statutes, government sponsored program requirements, and network access standards.
• Hires, trains, manages and evaluates team member performance.

Qualifications

• At least 7 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and or Marketplace products.
• At least 1 year of management/leadership experience.
• Strong understanding of the health care delivery system, including government-sponsored health plans.
• 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.
• Strong interpersonal skills, including ability to interface with providers and medical office staff.
• Experience with preparing and presenting formal presentations.
• Project management experience.
• Ability to work in a cross-functional highly matrixed organization.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Requirements

• Contract negotiation experience.

Benefits

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.