Provider Relations Manager (SNF & Ancillary)

Network Provider Relations

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. They are responsible for network management including provider education, communication, satisfaction, issue intake, access / availability, and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as the primary point of contact between Molina Health plan and the Plan's Complex Provider Community that services Molina members, including but not limited to Value Based Payment and other Alternative Payment Method contracts. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

• Under general supervision, works directly with the Plan's external complex providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service.
• Resolves complex provider issues that may cross departmental lines including Contracting, Finance, Quality, Operations, and involve Senior Leadership.
• Responsible for Provider Satisfaction survey results.
• Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise.
• Facilitates strategic planning and documentation of network management standards and processes. Effectiveness is tied to financial and quality indicators.
• Works collaboratively with functional business unit stakeholders to lead and / or support various provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization.
• MCST matrix team environmental support including, but not limited to : New Markets Provider / Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services.
• Serves as a subject matter expert for other departments.
• Conducts regular provider site visits within assigned region / service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals.
• Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.
• Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible.
• Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians.
• Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan.
• Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives.
• Trains other Provider Relations Representatives as appropriate.
• Role requires 40%+ same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

Required Education : Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience.

Required Experience / Knowledge, Skills & Abilities :

Preferred Education : Master's Degree in Health or Business related field

Preferred Experience :

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. Pay Range : $60,415 - $117,809 / ANNUAL