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Provider Program Manager

Passport Health Plan by Molina Healthcare Kentucky Job ID 2006472
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Passport Health Plan by Molina Healthcare has a mission to provide quality health care to those who need it, no matter their circumstances. Today, Molina health plans serve 3,331,000 members across the country through government-funded programs. Each day, we work to earn the trust our partners and members put in us, so they can lean on Molina. Together, Passport Health Plan and Molina share a commitment to improving the health and quality of life of our members across the Commonwealth of Kentucky.

  • Full Time, Part Time
  • Level: All Levels
  • Travel: Occassional
  • passport-logo

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Success Profile

What makes you successful at Passport Health Plan by Molina Healthcare? Check out the traits we’re looking for and see if you're the right fit!

  • Compassionate
  • Consultive
  • Patient
  • Problem-Solver
  • Sincere
  • Relationship Expertise

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  • Insurance

    Medical · Dental · Vision
    Group & Voluntary Life Insurance
    Aflac · Pet Health · Identity Theft
    Auto & Home Insurance

  • Savings

    Flexible Spending Accounts
    401K · Roth 401K
    Employee Stock Purchase Plan

  • Career Growth

    Continuing Education Units
    Education Reimbursement

  • Time Off

    Paid Time Off
    Volunteer Time Off
    Company Holidays

  • Additional Perks

    Legal Assistance Plan
    Employee Assistance & Well Being Programs
    Employee Perks Platform
    Rideshare Portal

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Job Description

Job Summary
The Provider Program Manager is part of our innovative Enterprise Risk Adjustment Team at the Health Plan level who provides oversight of network strategies and relationship development activities for assigned providers including but not limited to: individualized planning, training and development of providers to align with Molina's Risk Adjustment and Quality initiatives.

Accountable for proactively identifying issues, resolving disputes, and coordinates resolutions, implementing and managing assigned providers activities from start through completion of the program. Providing providers with monthly statuses of their progress and provide opportunities for training on the importance of documenting, closing gaps in care, and billing and submitting a claim. This role supports the strategic direction and organization of corporate initiatives to facilitate achievement of the provider engagement programs.

This role interacts and supports regulatory agency policy and procedures by acting as a key business partner to the Health Plan Case Management, Provider Engagement Team, and Provider Services departments.

The position's essential functions are as follows:
• Tailor programs for providers
a) document processes and changes
b) create formal processes for the program (visit already completed for example)
c) creates and delivers presentations
d) meets with leadership at the larger group level to discuss progress in form of JOCs or other routine scheduled visits
• Manage provider relationships and must be proficient in discussing gaps, risk scores, claims etc. Identifies functioning processes and process improvement opportunities and follow up with resolution
• Build strong relationships with providers to ensure open communication is welcomed and openly received
• Travel scheduled provider visits or related meetings
• Reliable and able to work independently
• Full Risk Adjustment program management role
• Knowledge in Value Based Contract outreach efforts preferred
• Knowledge of Visio to diagram processes
• Some experience working with data
• Experience with Microsoft Excel, Word, PowerPoint
• Claims knowledge to validate provider payment
• Create PowerPoint presentations and deliver to case management and other relevant departments
• Manage member incentives

Job Qualifications
Required Education
Associates Degree or equivalent experiences
Required Experience
• 3-5 years managed care experience, preferably with a national or multi-location organization
• Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliancy
• Proven ability to innovate and drive organizational change
• Excellent presentation and communication skills

Preferred Education
Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience is preferred.

Preferred License, Certification, Association
• Preferred Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC). Certified Coding Specialist (CCS) is considered.

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.

Job Type: Full Time Posting Date: 03/03/2021

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