Manager, Health Plan Provider Relations (Michigan)

Molina Healthcare•Long Beach, MI

About The Position

The Manager, Health Plan Provider Relations leads and manages the team responsible for health plan provider relations activities. The role supports network development, network adequacy, and provider training and education, and serves as the primary point of contact between the business and contracted providers in the Molina network. It manages provider education, communication, satisfaction, issue intake, access and availability, and provider knowledge of 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 in this role must reside in Michigan.

Requirements

At least 7 years of provider services experience, including support for 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 (FFS), capitation and other forms of risk, 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 work with providers and medical office staff.
Ability to work in a cross-functional, highly matrixed organization.
Strong verbal and written communication skills.
Proficiency with the Microsoft Office suite and applicable software programs.
Must reside in Michigan.

Nice To Haves

Contract negotiation experience.

Responsibilities

Oversee the plan’s provider relations function, team members, and daily departmental operations, including provider education, outreach, and inquiry resolution.
Develop health plan-specific provider relations strategies with provider network leadership, identifying specialties and geographic locations where resources should be concentrated to establish a sufficient participating provider network.
Oversee provider representatives’ activities, including developing or presenting policies, procedures, training materials, and reports.
Support ongoing provider network development and educate contracted network 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 when providers raise issues or complaints, including those involving claims and encounter data, eligibility, reimbursement, or the provider website.
Support plan initiatives and help ensure regulatory requirements and strategic goals are met.
Ensure cross-departmental communication about provider relations initiatives and contracted network provider issues.
Design and implement programs that build and nurture positive relationships among contracted providers, ancillary providers, hospital facilities, and the plan.
Develop and implement strategies to increase provider engagement in HEDIS and quality initiatives.
Engage contracted network providers in cost-control initiatives, medical cost ratio (MCR), 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 its alignment with departmental requirements, provider education, and oversight.
Hire, train, manage, and evaluate team members; provide coaching, development, and recognition; ensure appropriate ongoing staff training; hold regular team meetings; and promote communication and collaboration.