Provider Relations Manager

1 week ago


Springfield, Illinois, United States Molina Healthcare Full time
Job Overview

***Remote position; candidates must reside in Illinois***

Position Summary

Molina Healthcare is seeking a dedicated professional to oversee our Provider Relations team. This role is crucial for the development and maintenance of our healthcare provider network, ensuring compliance with all relevant regulations while aligning with Molina's mission and strategic objectives.

Key Responsibilities

As the Manager of Provider Relations, you will:

  • Lead the Provider Relations team, ensuring efficient daily operations and collaboration with various departments to enhance provider services.
  • Work closely with the Director of Provider Network Management to formulate specific contracting strategies aimed at establishing a robust network of participating providers.
  • Guide external provider representatives, creating and delivering training materials and reports that adhere to both internal and external standards.
  • Oversee the recruitment, training, and performance evaluation of Provider Service staff.
  • Facilitate ongoing development of the provider network while educating contracted providers on plan procedures and claims processing.
  • Implement tracking mechanisms to ensure timely resolution of issues and adherence to applicable standards.
  • Act as a point of contact for providers experiencing issues or complaints, ensuring effective communication and resolution.
  • Support Molina's initiatives to meet regulatory requirements and strategic goals.
  • Foster positive relationships with contracted providers, ancillary providers, and hospital facilities.
  • Develop strategies to enhance provider engagement in quality initiatives and cost control measures.
  • Manage the IHH program, ensuring alignment with departmental requirements and effective provider education.

Qualifications

Education:

Bachelor's Degree in a Health or Business-related field or equivalent experience.

Experience and Skills:

  • 5-7 years of experience in servicing healthcare providers, including physicians and hospitals, particularly in Medicaid and/or Medicare environments.
  • 5+ years of experience in managed healthcare.
  • Familiarity with community agencies and provider operations.
  • Understanding of various managed healthcare compensation methodologies.
  • Experience in preparing and delivering formal presentations.
  • 2+ years in a leadership role, with a minimum of 2 years in a supervisory capacity.

Preferred Qualifications:

Master's Degree in a Health or Business-related field.

5-7 years of experience in managed healthcare administration, with specific expertise in provider services and contract negotiations.

Molina Healthcare offers a competitive compensation and benefits package. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $59, $129,589.63 / ANNUAL
*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.



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