Kentucky Staffing
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 Under general supervision, 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. Resolves complex provider issues that may cross departmental lines and involve Senior Leadership. 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. 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 80%+ same-day or overnight travel. Job Qualifications Required Education: Bachelors Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience/Knowledge, Skills & Abilities: 3 - 5 years customer service, provider service, or claims experience in a managed care setting. 3+ years experience in managed healthcare administration and/or Provider Services. Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc. Preferred Experience: 5+ years experience in managed healthcare administration and/or Provider Services. 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals). 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: $47,433 - $97,362.61 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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 Under general supervision, 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. Resolves complex provider issues that may cross departmental lines and involve Senior Leadership. 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. 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 80%+ same-day or overnight travel. Job Qualifications Required Education: Bachelors Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience/Knowledge, Skills & Abilities: 3 - 5 years customer service, provider service, or claims experience in a managed care setting. 3+ years experience in managed healthcare administration and/or Provider Services. Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc. Preferred Experience: 5+ years experience in managed healthcare administration and/or Provider Services. 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals). 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: $47,433 - $97,362.61 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.