Dir, Provider ServicesMolina Healthcare Reno, Nevada Job ID 2009150
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 (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):
• Responsible for providing and developing standards and resources to help the Molina health plan successfully develop and refine cost effective and high quality strategic provider networks, establishing both internal and external long-term partnerships.
• Works collaboratively with health plan network management and operations teams and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives with an emphasis on developing and implementing standards, resources, tools and best practices sharing across the organization.
• Develops and deploys strategic network planning tools to drive provider services and contracting strategy across the organization. Facilitates planning and documentation of network management standards and processes for all line of business.
• Provides matrix team support including, but not limited to: New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services.
• Builds and/or performs provider communication, training & education programs for internal staff, external providers, and other stakeholders.
• Ensures compliance with applicable company/plan business requirements including state/federal statutes, government sponsored program requirements, and network access standards.
• BA or BS Degree or commensurate/equivalent experience in provider services or contract network development and management in a managed healthcare setting.
• 7 years experience in managed healthcare administration.
• Experience demonstrating working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicare or Medicaid lines of business, including but not limited to: fee-for service, capitation and delegation models, and various forms of risk, ASO, agreements, etc.
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
MA or MS preferred
10 years managed healthcare administration experience.
Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals).
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
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: 07/13/2021
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