Manager, Provider Relations
Company: Molina Healthcare
Location: Chicago
Posted on: May 7, 2024
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Job Description:
***Remote and must live in Illinois***
Job Description
Job Summary
Molina Health Plan Network Provider Relations 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 Relations staff are
the primary point of contact between Molina Healthcare and
contracted provider network. -In partnership with Director, manages
and coordinates the Provider Services activities for the state
health plan. Works with direct management, corporate, and staff to
develop and implement standardized provider servicing and
relationship management plans.
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Job Duties
Manages the Plan's Provider Relations 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
Services functions with an emphasis on contracting, education,
outreach and resolving provider inquiries.
--- In conjunction with the Director, Provider Network Management &
Operations, 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 Service 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 Service's 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
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Job Qualifications
REQUIRED EDUCATION:
Bachelor's Degree in Health or Business related field or equivalent
experience.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
--- - 5-7 years experience 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.
--- Previous experience with community agencies and providers. - -
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--- 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, value-based contracts, capitation
and delegation models, and various forms of risk, ASO, agreements,
etc. -
--- Experience with preparing and presenting formal
presentations.
--- 2+ years in a direct or matrix leadership position
--- Min. 2 years experience managing/supervising employees.
PREFERRED EDUCATION:
Master's Degree in Health or Business related field - -
PREFERRED EXPERIENCE:
--- 5-7 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).
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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.
#PJCorp Pay Range: $59,810.6 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level.
Keywords: Molina Healthcare, Racine , Manager, Provider Relations, Executive , Chicago, Wisconsin
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