Provider Relations Manager_

Seattle

Remote and must live in Washington

**Job Summary**

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**

This role serves as the primary owner of provider communications for the health plan, including print, website, and provider manual content development and maintenance. The role regularly translates complex changes in billing guidelines, clinical guidelines, and regulatory changes into concise talking points and trainings that are easily understood by internal and external stake holders. This role also manages complex program implementations for Provider Relations team. They may also act as a representative between Molina Health plan and the Plan's Complex Provider Community that services Molina members, including but not limited to Value Based Payment and other Alternative Payment Method contracts. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

• With minimal supervision, writes and develops content to support the creations of internal and external communications to Molina's Provider Network and other stakeholders.

• Edits, proofs, and reviews all communications to meet the Molina tone, voice, and style requirements.

• 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 JOCs).

• Manages end-to-end planning of Molina provider trainings and in-person events.

• Under general supervision, works directly with the Plan’s external complex 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 including Contracting, Finance, Quality, Operations, and involve Senior Leadership.

• Responsible for Provider Satisfaction survey results and partnering with Senior Leaders to develop Provider Satisfaction annual plan.

• 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 and/or support various provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization.

• Serves as a subject matter expert for other departments, and as Provider Communications subject matter expert for the Network Department.

• 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. 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.

• 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.

• When required, role may expand to include management of complex provider relationships:

• 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.

• 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.

• 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.

• Role requires 20%+ 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** :

Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.

**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :

• 2+ years provider contract network relations and management experience in a managed healthcare setting.

• Excellent writing, editing, and verbal communications skills.

• Working experience servicing complex providers with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, value-based contracts, capitation and various forms of risk, ASO, etc.

• Excellent organization and demonstrated project management skills.

• Strong ability to collaborate with leaders in other departments to ensure success of cross-functional projects.

**PREFERRED EDUCATION** :

Master’s Degree in Health or Business related field

**PREFERRED EXPERIENCE** :

• 5 years experience in managed healthcare administration.

• Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals).

• Experience in event planning

• Experience in survey development and analyzing customer insights

• Experience developing digital healthcare communications

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.

\#PJCorp

Pay Range: $67,724.8 - $117,808.76 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.