Manager, Health Plan Provider Relations (Michigan)

Molina Healthcare•Detroit, MI

1d•$66,456 - $129,590

About The Position

The Manager, Health Plan Provider Relations leads the team responsible for health plan provider relations activities and supports network development, network adequacy, and provider training and education. The role serves as the primary point of contact between the business and contracted providers in the Molina network, managing provider education, communication, satisfaction, issue intake, access and availability, and compliance with Molina policies and procedures. The manager collaborates with network leadership and the corporate network team to develop and implement standardized provider relationship management and provider services for the health plan. The employee must reside in Michigan. The manager oversees daily department operations and provider relations activities, develops health plan-specific strategies to maintain a sufficient provider network, and leads provider representative work. The role also oversees the Integrated Health Home (IHH) program, supports regulatory and strategic goals, and manages staff through hiring, training, coaching, performance evaluation, and team development.

Requirements

At least 7 years of provider services experience, including 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.
At least 1 year of management or leadership 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 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 suite and applicable software programs.

Nice To Haves

Contract negotiation experience.

Responsibilities

Oversee the plan’s provider relations function, team members, and daily department operations, including provider education, outreach, and inquiry resolution.
Develop health plan-specific provider relations strategies with provider network leadership, focusing resources on specialties and geographic areas to establish a sufficient participating provider network.
Oversee provider representative activities, including developing or presenting policies, procedures, training materials, and reports.
Support ongoing provider network development and educate contracted providers about plan procedures and claims payment policies.
Develop and implement tracking tools to support timely issue resolution and compliance with applicable provider relations standards.
Oversee timely interventions and communications for provider issues or complaints, including claims and encounter data, eligibility, reimbursement, and provider website problems.
Support plan initiatives and help ensure regulatory requirements and strategic goals are met.
Ensure cross-departmental communication about provider relations initiatives and contracted provider issues.
Design and implement programs to build and nurture positive relationships with contracted providers, ancillary providers, hospital facilities, and the plan.
Develop and implement strategies to increase provider engagement in HEDIS and quality initiatives.
Engage contracted providers on cost control initiatives, medical cost ratio, non-emergent utilization, and CAHPS to positively influence future trends.
Develop and implement strategies to reduce member access grievances involving contracted providers.
Oversee the Integrated Health Home (IHH) program and ensure alignment with departmental requirements, provider education, and oversight.
Hire, train, manage, and evaluate team members; provide coaching, development, and recognition; ensure ongoing staff training; and promote communication and collaboration through regular team meetings.