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Inc. is the voice of the American entrepreneur, inspiring and documenting the risk-takers and ultra-driven go-getters who represent the most dynamic force in the American economy.
Fast Company is the world’s leading business media brand, focusing on innovation in technology, leadership, and design to inspire readers to shape the future of business.

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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.

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, focusing on FQHC, large provider groups, and Behavioral Health. 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.

Job Duties:

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.
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. 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.
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. 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. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.
Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. 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).
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. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).
Trains other Provider Relations Representatives as appropriate.
Role requires 30+% same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.)

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:

2 - 3 years customer service, provider service, or claims experience in a managed care setting.
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 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.
FQHC, large provider groups, and Behavioral Health

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: $17.85 - $38.69 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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Molina Health Plan Network Provider Relations

Molina Health Plan Network Provider Relations jobs are responsible for network developmen...","Representative, Provider Relations HP (Idaho HealthPlan)","Idaho Falls, ID, US, 83401",["B","2619324110"],"Work at Idaho Staffing","4 days ago","/jobs/2619324110-representative-provider-relations-hp-idaho-healthplan","/jobs?keyword=Idaho+Staffing","/jobs?location=Idaho+Falls%2C+ID%2C+US%2C+83401","/jobs?keyword=Representative%2C+Provider+Relations+HP+%28Idaho+HealthPlan%29",{"_429":428,"_434":537,"_452":453,"_444":445,"_243":538,"_441":539,"_427":428,"_111":437,"_431":194,"_433":194,"_454":453,"_442":540,"_425":541,"_455":456,"_430":118,"_476":542,"_460":543,"_478":437,"_479":540,"_481":482,"_483":544,"_485":486},["D",1770364800000],"Job Description

JOB DESCRIPTION Job Summary\nProvides support 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.

Essential Job Duties

• Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.\n• Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.\n• 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; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.\n• 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 determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.\n• Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship.\n• Independently troubleshoots provider problems as they arise, and 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.\n• 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).\n• Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; 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 joint operating committees (JOCs).\n• 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; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.).\n• May provide training and support to new and existing provider relations team members as appropriate.\n• Role requires 60%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).

Required Qualifications

• At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience.\n• General understanding of the health care delivery system, including government-sponsored health plans.\n• Organizational skills and attention to detail.\n• Ability to manage multiple tasks and deadlines effectively.\n• Interpersonal skills, including ability to interface with providers and medical office staff.\n• Ability to work in a cross-functional highly matrixed organization.\n• Effective verbal and written communication skills.\n• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.\n• Experience delivering training and facilitating educational presentations.

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\n","Job Description

JOB DESCRIPTION Job Summary\nProvides support for health plan provider relations activities. Supports network development, ...","Long Beach, California, us, 90899",["B","2457197574"],"13 days ago","/jobs/2457197574-representative-health-plan-provider-relations","/jobs?location=Long+Beach%2C+California%2C+us%2C+90899",{"_429":428,"_434":546,"_452":453,"_444":445,"_243":547,"_441":548,"_427":428,"_111":549,"_431":194,"_433":194,"_454":453,"_442":550,"_425":551,"_455":456,"_430":118,"_476":552,"_460":553,"_478":554,"_479":550,"_481":482,"_483":555,"_485":556},["D",1770570000000],"Overview\nJOB 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\n*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

#J-18808-Ljbffr\n","Overview\nJOB DESCRIPTION

***Position requires travel throughout N Florida***

Job Summary

Provides subject matter experti...","Provider Relations Manager (Reside in N. FL: Jacksonville, Tampa, Tallahassee, O","California, Missouri, United States, 65018",["B","2490984873"],"10 days ago","/jobs/2490984873-provider-relations-manager-reside-in-n-fl-jacksonville-tampa-tallahassee-o","Provider Relations Manager (Reside in N. FL: Jacksonville, Tampa,...","/jobs?location=California%2C+Missouri%2C+United+States%2C+65018","/jobs?keyword=Provider+Relations+Manager+%28Reside+in+N.+FL%3A+Jacksonville%2C+Tampa%2C...","actionData","errors"]