Health Plan Provider Relations Manager (Michigan)

Molina Healthcare•Long Beach, MI

About The Position

The Health Plan Provider Relations Manager provides subject matter expertise and leadership for health plan provider relations activities, supporting network development, network adequacy, and provider training and education. The manager serves as the primary point of contact between the business and contracted providers within the Molina network and is responsible for network management, provider education and communication, provider satisfaction, issue intake, access and availability, and provider knowledge of and compliance with Molina policies and procedures. The employee must reside in Michigan. The role works with strategic, high-volume, and complex provider communities as well as non-complex providers, supporting provider satisfaction, education on Molina initiatives, partnership with the health plan, and timely resolution of issues. The manager conducts provider site visits, provides training and presentations, troubleshoots provider concerns, and coordinates problem-solving across Molina departments and with senior leadership and physicians. The position also contributes to strategic network planning, provider relations and contracting strategy, network management standards, and provider services best practices. It includes training and mentoring provider relations team members and requires 40% or more same-day or overnight travel within Michigan, depending on the health plan service area.

Requirements

At least 6 years of provider services experience supporting individual and 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, 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 delivering formal presentations.
Strong interpersonal skills and 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 and applicable software programs.
Must reside in Michigan.
Ability to travel 40% or more on same-day or overnight trips within Michigan.

Nice To Haves

Management or leadership experience.
Contract negotiation experience.

Responsibilities

Engage strategic, high-priority, high-volume, and complex providers, including providers with value-based payment and other alternative payment method contracts, to support satisfaction, education, coordination, and partnership.
Serve as the primary contact between the Molina health plan and non-complex providers serving Molina members, including fee-for-service and pay-for-performance providers.
Educate, advocate for, and engage external providers to promote compliance with Molina policies and procedures and deliver strong customer service.
Drive timely issue resolution, electronic medical record connectivity, and provider portal adoption.
Resolve complex provider issues that cross departments such as contracting, finance, quality, and operations, including issues involving senior leadership.
Conduct regular provider site visits in the assigned region or service area and plan schedules to meet or exceed monthly site-visit goals.
Assess provider compliance with Molina policies and procedures and CMS guidelines and regulations, and assess non-clinical customer service quality for Molina members.
Provide on-the-spot training and education, including diplomatically counseling providers while maintaining positive working relationships.
Troubleshoot provider problems and proactively prevent and resolve issues between providers and the health plan.
Initiate, coordinate, and participate in provider problem-solving meetings with Molina stakeholders, senior leadership, and physicians.
Deliver training and presentations to providers and staff, and present to larger groups such as provider-office leaders, health systems, executive decision-makers, association meetings, and joint operating committees.
Monitor and enforce company policies and procedures while educating providers and promoting participation in Molina initiatives, including administrative cost-effectiveness, member satisfaction, regulatory compliance, quality programs, and electronic solutions.
Oversee and demonstrate accountability for provider satisfaction survey results.
Develop and deploy strategic network planning tools to guide 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 and develop and implement organizational standards and best-practice sharing.
Navigate matrix-team support for new-market provider and contract services, issue resolution, and national contract management.
Serve as a subject matter expert for provider relations.
Train, mentor, and support new and existing provider relations team members.