[Hiring] Health Plan Provider Relations Manager @Molina Healthcare

Role Description

Provides subject matter expertise and leadership 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.

• Successfully engages the plan's highest priority, high-volume and strategic complex provider community providers (including value-based payment (VBP) and other alternative payment method (APM) contracts to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
• Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
• Collaborates directly with the plan’s external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
• Resolves complex provider issues that may cross departmental lines including contracting, finance, quality, operations, and may involve senior leadership.
• Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
• Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship.
• Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible.
• Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians.
• Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the health plan.
• Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives.
• Oversees and demonstrates accountability for provider satisfaction survey results.
• Develops and deploys strategic network planning tools to drive provider relations and contracting strategy across the enterprise.
• Facilitates strategic planning and documentation of network management standards and processes.
• Works collaboratively with functional business unit stakeholders to lead and/or support various provider services functions.
• Navigates the matrix team environment including new markets provider/contract support services, resolution support, and national contract management support services.
• Serves as a subject matter expert for the provider relations function.
• Provides training, mentoring, and support to new and existing provider relations team members.
• Role requires 80%+ same-day or overnight travel.

Qualifications

• At least 6 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, or equivalent combination of relevant education and experience.
• Strong understanding of the health care delivery system, including government-sponsored health plans.
• Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business.
• 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, including ability to interface with providers and medical office staff.
• 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

• Management/leadership experience.
• Contract negotiation experience.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.