Mgr, Provider Network Relations

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 Network staff are the primary point of contact between Molina Healthcare and provider network and are responsible for end-to-end relationship and management. They are responsible for provider contracting, 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
Manages the Plan's Provider Network functions and team members. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Network functions with an emphasis on contracting, education, outreach and resolving provider inquiries.
• In conjunction with the AVP ,Provider Network Operations & Contracting , develops health plan-specific provider contracting strategies, identifying 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 patients or members.
• Oversees and leads the functions of the external provider representatives, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards.
• Manages and directs the Provider Network staff including hiring, training and evaluating performance.
• Assists with ongoing provider network development and the education of contracted network providers regarding plan procedures and claim payment policies.
• Develops and implements tracking tools to ensure timely issue resolution and compliance with all applicable standards.
• Oversees appropriate and timely intervention/communication when providers have issues or complaints (e.g., problems with claims and encounter data, eligibility, reimbursement, and provider website).
• Serves as a resource to support Plan's 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 programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and Plan.
• Develops and implements strategies to increase provider engagement in HEDIS and quality initiatives.
• Engages contracted network providers regarding cost control initiatives, Medical Care Ratio (MCR), non-emergent utilization, and CAHPS to positively influence future trends.
• Develops and implements strategies to reduce member access grievances with contracted providers.
• Oversees the IHH program and ensures IHH program alignment with department requirements, provider education and oversight, and general management of the IHH program

* Candidates can reside in following locations: Syracuse, Buffalo and Rochester

Job Qualifications
Required Education
Bachelor's Degree in Health or Business related field or equivalent experience.
Required Experience
• 5 years experience involving servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products.
• 5+ years previous managed healthcare experience.
• 2 years previous supervisory experience.
• Previous experience with community agencies and providers.
• Experience with preparing and presenting formal presentations.
Preferred Education
Master's Degree in Health or Business related field

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.