Manager, Provider Services
Remote and must live in Inland Empire of California
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JOB DESCRIPTION
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Job Summary
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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;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.
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KNOWLEDGE/SKILLS/ABILITIES
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Manages the Plan&s;s Provider Services 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 education, outreach and resolving provider inquiries.
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- 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.
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- Manages and directs the Provider Service staff including hiring, training and evaluating performance.
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- Assists with ongoing provider network development and the education of contracted network providers regarding plan procedures and claim payment policies.
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- Develops and implements tracking tools to ensure timely issue resolution and compliance with all applicable standards.
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- 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).
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- Serves as a resource to support Plan&s;s initiatives and help ensure regulatory requirements and strategic goals are realized.
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- Ensures appropriate cross-departmental communication of Provider Service&s;s initiatives and contracted network provider issues.
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- Designs and implements programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and Plan.
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- Develops and implements strategies to increase provider engagement in HEDIS and quality initiatives.
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- Engages contracted network providers regarding cost control initiatives, Medical Care Ratio (MCR), non-emergent utilization, and CAHPS to positively influence future trends.
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- Develops and implements strategies to reduce member access grievances with contracted providers.
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- Assists with recredentialing contracted network providers, if needed.
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JOB QUALIFICATIONS
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Required Education
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Bachelor&s;s Degree in Health or Business-related field or equivalent experience.
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Required Experience
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- 5 years' experience involving servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products.
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- 5
years previous managed healthcare experience. - n
- 2 years previous supervisory experience in managed care preferred
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- Previous experience with community agencies and providers.
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- Experience with preparing and presenting formal presentations.
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Preferred Education
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Master&s;s Degree in Health or Business-related field
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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.
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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:
$60,414 - $117,808 a year
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Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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#PJHPO
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#LI-BEMORE
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Salary:
$60,414 - $117,808 per yearEstimated Salary: $20 to $28 per hour based on qualifications.
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