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AVP, Network Management & Operations

Passport Health Plan by Molina Healthcare Louisville, Kentucky Job ID 2010878
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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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Benefits

  • 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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Responsibilities

Knowledge/Skills/Abilities
• Develops and implements provider network and contract strategies, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's membership.
• Develops and maintains a market-specific Provider Reimbursement Strategy consistent with Reimbursement Tolerance Parameters (across multiple specialties/geographies). Oversee the development of new reimbursement models. Obtains input from Corporate and Legal regarding new reimbursement models.
• Develops and maintains a system to track Contract Negotiation activity on an ongoing basis throughout the year; utilize and oversees departmental training on the Emptoris contract management system.
• Directs the preparation and negotiations of provider contracts and oversee negotiation of contracts in concert with established company templates and guidelines with physicians, hospitals, and other health care providers.
• Contributes as a key member of the Senior Leadership Team and other committees addressing the strategic goals of the department and organization.
• Oversees the maintenance of all Provider contract information, Provider Contract Templates and assure that all contracts negotiated can be configured in the QNXT system. Works with legal and Corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Oversees Plan specific Fee schedule management.
• Develops strategies to improve EDI/MASS rates.
• Provides oversight of Provider Services and coordinates activities with Provider Association(s) and Joint Operating Committee Management.
• Provides accountability for Delegation Oversight function in the Plan.
• Provides oversight of the Provider Network Administration area including: Provider Information Management (PIM) and business analyses of contracts and benefits to support accurate configuration for claims payment.
• Oversees all Provider/Member problem prevention, research and resolution and provide oversight of the Provider/Member Appeals and Grievance process.
• Coordinates with enrollment growth to ensure that Molina grows faster (profitable growth) than our competitors in key provider practices..
Job Qualifications

Required Education
Bachelor's Degree in a related field (Business Administration, etc.) or equivalent combination of years of experience in lieu of Degree.
Required Experience
7-9 years
Preferred Education
Master's Degree in related field (Business Administration, etc.)

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.
 

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: 10/19/2021

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