Molina Healthcare
Manager, Provider Network Relations (Must reside in Georgia)
Molina Healthcare, Georgia Center, Vermont, United States
Overview
Manager, Provider Network Relations (Must reside in Georgia) Join to apply for the
Manager, Provider Network Relations (Must reside in Georgia)
role at
Molina Healthcare . Responsibilities
Manage the Plan's Provider Network functions and team members, overseeing daily operations and collaborating with other departments to lead or support provider network functions with an emphasis on contracting, education, outreach, and resolving provider inquiries. Develop health plan–specific provider contracting strategies with the Director, Provider Network Management & Operations, identifying specialties and geographic locations to establish a sufficient network of Participating Providers. Lead external provider representatives by developing and presenting policies, procedures, training materials, and reports to meet internal/external standards. Hire, train, and evaluate the Provider Network staff; support ongoing provider network development and education of contracted providers regarding plan procedures and claim payment policies. Develop and implement tracking tools to ensure timely issue resolution and compliance with applicable standards. Coordinate timely intervention and communications when providers have issues or complaints (e.g., claims, encounter data, eligibility, reimbursement, provider website). Support Plan initiatives to ensure regulatory requirements and strategic goals are realized and ensure cross-departmental communication of Provider Network initiatives and contracted provider issues. Design and implement programs to build relationships between contracted providers, ancillary providers, hospital facilities, and the Plan. Develop and implement strategies to increase provider engagement in HEDIS and quality initiatives; engage contracted providers regarding cost control initiatives, MCR, non-emergent utilization, and CAHPS to influence future trends. Develop strategies to reduce member access grievances with contracted providers and oversee the IHH program for alignment with department requirements and oversight. Qualifications
Required Education Bachelor's Degree in Health or Business-related field or equivalent experience. Required Experience 5 years’ experience involving servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products. 5+ years of managed healthcare experience. 2 years of supervisory experience. Experience with community agencies and providers. Experience with preparing and presenting formal presentations. Preferred Education Master's Degree in Health or Business-related field Additional Information
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $73,102 - $142,549 / ANNUAL. Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#J-18808-Ljbffr
Manager, Provider Network Relations (Must reside in Georgia) Join to apply for the
Manager, Provider Network Relations (Must reside in Georgia)
role at
Molina Healthcare . Responsibilities
Manage the Plan's Provider Network functions and team members, overseeing daily operations and collaborating with other departments to lead or support provider network functions with an emphasis on contracting, education, outreach, and resolving provider inquiries. Develop health plan–specific provider contracting strategies with the Director, Provider Network Management & Operations, identifying specialties and geographic locations to establish a sufficient network of Participating Providers. Lead external provider representatives by developing and presenting policies, procedures, training materials, and reports to meet internal/external standards. Hire, train, and evaluate the Provider Network staff; support ongoing provider network development and education of contracted providers regarding plan procedures and claim payment policies. Develop and implement tracking tools to ensure timely issue resolution and compliance with applicable standards. Coordinate timely intervention and communications when providers have issues or complaints (e.g., claims, encounter data, eligibility, reimbursement, provider website). Support Plan initiatives to ensure regulatory requirements and strategic goals are realized and ensure cross-departmental communication of Provider Network initiatives and contracted provider issues. Design and implement programs to build relationships between contracted providers, ancillary providers, hospital facilities, and the Plan. Develop and implement strategies to increase provider engagement in HEDIS and quality initiatives; engage contracted providers regarding cost control initiatives, MCR, non-emergent utilization, and CAHPS to influence future trends. Develop strategies to reduce member access grievances with contracted providers and oversee the IHH program for alignment with department requirements and oversight. Qualifications
Required Education Bachelor's Degree in Health or Business-related field or equivalent experience. Required Experience 5 years’ experience involving servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products. 5+ years of managed healthcare experience. 2 years of supervisory experience. Experience with community agencies and providers. Experience with preparing and presenting formal presentations. Preferred Education Master's Degree in Health or Business-related field Additional Information
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $73,102 - $142,549 / ANNUAL. Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#J-18808-Ljbffr