Provider Relations Manager (Reside in N. FL: Jacksonville, Tampa, Tallahassee, O
Molina Healthcare, Florida, New York, United States
Overview
JOB DESCRIPTION
***Position requires travel throughout N Florida***
Job Summary
Provides subject matter expertise and leadership for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures.
Responsibilities
Successfully engages the plan\'s highest priority, high-volume and strategic complex provider community providers (including value-based payment (VBP) and other alternative payment method (APM) contracts) to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
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 (FFS) and pay-for-performance (P4P) providers.
Collaborates 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; drives timely issue resolution, EMR connectivity, and provider portal adoption.
Resolves complex provider issues that may cross departmental lines including contracting, finance, quality, operations, and may involve senior leadership.
Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule to meet or exceed the plan\'s monthly site visit goals; proactively engages with the provider and staff to address non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess non-clinical quality of customer service for Molina members.
Provides on-the-spot training and education as needed, including counseling providers diplomatically while maintaining positive working relationships.
Independently troubleshoots provider problems as they arise and takes initiative in preventing and resolving issues between the provider and the plan whenever possible.
Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include issues related to utilization management, pharmacy, quality of care, and correct coding).
Independently delivers training and presentations to assigned providers and their staff; may also deliver training to larger groups, including leaders and management of provider offices, large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
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 Molina initiatives (e.g., CAHPS, regulatory-related activities, Molina quality programs, and electronic solutions such as EDI, EMR, provider portal, provider website, etc.).
Oversees and demonstrates accountability for provider satisfaction survey results.
Develops and deploys strategic network planning tools to drive provider relations and contracting strategy across the enterprise.
Facilitates strategic planning and documentation of network management standards and processes; effectiveness is tied to financial and quality indicators.
Works collaboratively with functional business unit stakeholders to lead or support provider services functions with an emphasis on developing and implementing standards and best practice sharing across the organization.
Navigates the matrix team environment including new markets provider/contract support services, resolution support, and national contract management support services.
Serves as a subject matter expert for the provider relations function.
Provides training, mentoring, and support to new and existing provider relations team members.
Role requires 20%+ same-day or overnight travel (extent of travel depends on the specific health plan service area).
Required Qualifications
At least 6 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and/or Marketplace products, or equivalent combination of relevant education and experience.
Strong understanding of the health care delivery system, including government-sponsored health plans.
Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including FFS, capitation and various forms of risk, ASO, etc.
Previous experience with community agencies and providers.
Strong organizational skills and attention to detail.
Ability to manage multiple tasks and deadlines effectively.
Experience with preparing and presenting formal presentations.
Strong interpersonal skills, including ability to interface with providers and medical office staff.
Ability to work in a cross-functional highly matrixed organization.
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
Management/leadership experience.
Contract negotiation experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
#PJCorp
#LI-AC1
Pay Range: $60,415 - $117,809 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#J-18808-Ljbffr
***Position requires travel throughout N Florida***
Job Summary
Provides subject matter expertise and leadership for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures.
Responsibilities
Successfully engages the plan\'s highest priority, high-volume and strategic complex provider community providers (including value-based payment (VBP) and other alternative payment method (APM) contracts) to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
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 (FFS) and pay-for-performance (P4P) providers.
Collaborates 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; drives timely issue resolution, EMR connectivity, and provider portal adoption.
Resolves complex provider issues that may cross departmental lines including contracting, finance, quality, operations, and may involve senior leadership.
Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule to meet or exceed the plan\'s monthly site visit goals; proactively engages with the provider and staff to address non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess non-clinical quality of customer service for Molina members.
Provides on-the-spot training and education as needed, including counseling providers diplomatically while maintaining positive working relationships.
Independently troubleshoots provider problems as they arise and takes initiative in preventing and resolving issues between the provider and the plan whenever possible.
Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include issues related to utilization management, pharmacy, quality of care, and correct coding).
Independently delivers training and presentations to assigned providers and their staff; may also deliver training to larger groups, including leaders and management of provider offices, large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
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 Molina initiatives (e.g., CAHPS, regulatory-related activities, Molina quality programs, and electronic solutions such as EDI, EMR, provider portal, provider website, etc.).
Oversees and demonstrates accountability for provider satisfaction survey results.
Develops and deploys strategic network planning tools to drive provider relations and contracting strategy across the enterprise.
Facilitates strategic planning and documentation of network management standards and processes; effectiveness is tied to financial and quality indicators.
Works collaboratively with functional business unit stakeholders to lead or support provider services functions with an emphasis on developing and implementing standards and best practice sharing across the organization.
Navigates the matrix team environment including new markets provider/contract support services, resolution support, and national contract management support services.
Serves as a subject matter expert for the provider relations function.
Provides training, mentoring, and support to new and existing provider relations team members.
Role requires 20%+ same-day or overnight travel (extent of travel depends on the specific health plan service area).
Required Qualifications
At least 6 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and/or Marketplace products, or equivalent combination of relevant education and experience.
Strong understanding of the health care delivery system, including government-sponsored health plans.
Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including FFS, capitation and various forms of risk, ASO, etc.
Previous experience with community agencies and providers.
Strong organizational skills and attention to detail.
Ability to manage multiple tasks and deadlines effectively.
Experience with preparing and presenting formal presentations.
Strong interpersonal skills, including ability to interface with providers and medical office staff.
Ability to work in a cross-functional highly matrixed organization.
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
Management/leadership experience.
Contract negotiation experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
#PJCorp
#LI-AC1
Pay Range: $60,415 - $117,809 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#J-18808-Ljbffr