Provider Relations Representative - (LTSS Support; Ohio Based)

Job Description

Remote, role requires 10%+ same-day or overnight travel.

Ideal Candidate

must reside in Ohio with reliable transportation. Statewide travel as needed for provider visits, conferences, and events. At least quarterly in-office work is required.

Preferred experience with MyCare Ohio and LTSS.

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.

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 for 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.

Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.

Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals.

A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine; for example, non-compliance with Molina policies / procedures or CMS guidelines / regulations, or to assess the non-clinical quality of customer service provided to Molina members.

Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible.

The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.

For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.

May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's).

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 :

3+ years experience in managed healthcare administration and / or Provider Services.

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.

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Pay Range : $19.84 - $38.69 / HOURLY