JOB DESCRIPTION

Job Summary

Molina Health Plan Provider Network Management and Operations 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 Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

KNOWLEDGE/SKILLS/ABILITIES

The VP, Network Strategy and Services is responsible for the development and implementation of enterprise-wide initiatives and projects to support robust provider and member engagement in support of achieving positive operational and financial outcomes.

• Responsible for the continued development and enhancement of the Provider Network Management and Operations Department including the implementation of standard processes, policies, and procedures.
• Work closely with the health plans leadership to ensure compliance with all Molina, regulatory and industry standards.
• Support and execute new health plan implementations, acquisitions, and expansions in collaboration with the Business Development Team.
• Drive positive cultural changes with focus on coaching and development.
• Plans, organizes, staffs, and coordinates activities of the Provider Network Management and Operations Department.
• Works with staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to contain unit cost, improve member access and enhance Provider satisfaction enterprise wide.
• Develop a Standardized Provider Engagement “Tool Kit”, training program and deployment plan. Develop and implement approaches to determining outcomes of tools and training programs.
• Develop and oversee deployment strategy and monitoring for “Provider Profiles” and “Pay for Performance (P4P)” contracting.
• In conjunction with Provider Services and Provider Contracting leaders in the Health Plans and in collaboration with the MHI AVP of Provider Contracting identify, develop, and implement approaches for performance management of Value Based Reimbursement.
• Develop and refine “Clear Coverage” provider adoption strategies and assist in training of health plan staff as Clear Coverage is implemented in each Plan.
• Represent Provider Engagement with Stakeholder Experience, Quality and RAMP business partners to ensure we incorporate the necessary plans to achieve positive operational and financial outcomes.
• Monitor key metrics to determine Provider Engagement effectiveness and success (e.g., Provider Appeals and Grievances, Member Appeals and Grievances, CAHPs, STAR Ratings, HEDIS, HEP Completion Rates, etc.).

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience

Required Experience

Minimum 10+ years of management and strong leadership experience. Minimum 5 years of healthcare, managed care, provider services and call center operations experience in government sponsored programs. Excellent interpersonal and communication skills (verbal and written). Excellent leadership and managerial skills. Proven record of accomplishments in work history.

Preferred Education

Master's Degree

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.

Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.