Health Plan Provider Relations Manager (Michigan)

Molina Healthcare•Long Beach, CA

About The Position

The Health Plan Provider Relations Manager provides subject matter expertise and leadership for health plan provider relations activities. The role supports network development, network adequacy, provider training, and education, and serves as the primary point of contact between the business and contracted providers in the Molina network. Responsibilities include managing provider education, communication, satisfaction, issue intake, access and availability, and compliance with Molina policies and procedures. The employee must reside in Michigan, and the role requires 40% or more same-day or overnight travel within Michigan, depending on the health plan service area. The manager engages high-priority, high-volume, strategic, and complex providers, including providers participating in value-based payment and other alternative payment arrangements, as well as non-complex fee-for-service and pay-for-performance providers. The role works with providers to improve satisfaction, educate them about Molina initiatives, encourage coordination and partnership, resolve issues, support electronic medical record connectivity and provider portal adoption, and deliver training and presentations. It also conducts provider site visits; coordinates problem-solving across departments and with leadership; monitors provider satisfaction; contributes to network planning, standards, and processes; and supports provider relations team members through training and mentoring.

Requirements

At least 6 years of provider services experience supporting individual or group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and/or Marketplace products, or an equivalent combination of relevant education and experience.
Strong understanding of the health care delivery system, including government-sponsored health plans.
Experience with managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including fee-for-service, capitation, risk arrangements, and ASO.
Previous experience with community agencies and providers.
Strong organizational skills and attention to detail.
Ability to manage multiple tasks and deadlines effectively.
Experience preparing and presenting formal presentations.
Strong interpersonal skills, including the 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.
Proficiency with Microsoft Office suite and applicable software programs.
Must reside in Michigan.
Ability to travel 40% or more same-day or overnight within Michigan, depending on the health plan service area.

Nice To Haves

Management or leadership experience.
Contract negotiation experience.

Responsibilities

Engage strategic, high-priority, high-volume, and complex providers, including those with value-based payment and other alternative payment contracts, to support satisfaction, education, coordination, and partnership.
Serve as the primary contact for non-complex providers serving Molina members, including fee-for-service and pay-for-performance providers.
Educate, advocate for, and engage providers as partners; promote knowledge of and compliance with Molina policies and procedures and provide customer service.
Drive timely resolution of provider issues, electronic medical record connectivity, and provider portal adoption.
Resolve complex provider issues that may involve contracting, finance, quality, operations, and senior leadership.
Conduct regular provider site visits within the assigned region and meet or exceed monthly site visit goals.
Assess provider compliance with Molina policies and procedures and applicable Centers for Medicare and Medicaid Services guidelines or regulations, and assess non-clinical customer service quality.
Provide on-the-spot provider training and education, including diplomatically counseling providers while maintaining positive working relationships.
Independently troubleshoot provider problems and take initiative to prevent and resolve issues between providers and the health plan.
Initiate, coordinate, and participate in problem-solving meetings between providers and Molina stakeholders, including leadership and physicians, on issues such as utilization management, pharmacy, quality of care, and coding.
Deliver training and presentations to providers and their staff, and as needed to larger provider groups, health systems, executive decision makers, association meetings, and joint operating committees.
Monitor and enforce company policies and procedures and promote provider participation in Molina initiatives, including administrative cost-effectiveness, member satisfaction, regulatory compliance, quality programs, and electronic solutions.
Oversee and be accountable for provider satisfaction survey results.
Develop and deploy strategic network planning tools to support provider relations and contracting strategy across the enterprise.
Facilitate strategic planning and documentation of network management standards and processes tied to financial and quality indicators.
Collaborate with functional business unit stakeholders to lead or support provider services functions and develop and implement standards and best-practice sharing.
Work within the matrix team environment, including new-markets provider and contract support, issue-resolution support, and national contract management support.
Serve as a subject matter expert for provider relations.
Train, mentor, and support new and existing provider relations team members.