Representative, Provider Relations HP (Must Reside in CA)

Molina Health Plan 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 non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

• Under minimal direction, works directly with the Plan's external 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.
• 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.
• 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 60%+ same-day or overnight travel.

Job Qualifications

REQUIRED EDUCATION : Associate's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.

REQUIRED EXPERIENCE / KNOWLEDGE, SKILLS & ABILITIES :

PREFERRED EDUCATION : Bachelor's Degree in a related field or an equivalent combination of education and experience

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 : $22.81 - $44.49 / HOURLY