Manager, Provider Relations
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About The Position
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 serve as the primary point of contact between Molina Healthcare and the contracted provider network. In partnership with the Director, this role manages and coordinates the Provider Services activities for the state health plan. The position requires collaboration with direct management, corporate, and staff to develop and implement standardized provider servicing and relationship management plans. The Manager of Provider Relations will oversee the Plan's Provider Relations functions and team members, ensuring the daily operations of the department run smoothly. This includes working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Services functions, with a strong emphasis on contracting, education, outreach, and resolving provider inquiries. The role involves developing health plan-specific provider contracting strategies, identifying specialties and geographic locations to concentrate resources for establishing a sufficient network of Participating Providers to serve the healthcare needs of the Plan's patients or members. Additionally, the Manager will oversee and lead the functions of external provider representatives, including developing and/or presenting policies and procedures, training materials, and reports to meet internal and external standards. The position also entails managing and directing the Provider Service staff, including hiring, training, and evaluating performance. The Manager will assist with ongoing provider network development and educate contracted network providers regarding plan procedures and claim payment policies. Furthermore, the role includes developing and implementing tracking tools to ensure timely issue resolution and compliance with all applicable standards, overseeing appropriate and timely intervention/communication when providers have issues or complaints, and serving as a resource to support the Plan's initiatives to ensure regulatory requirements and strategic goals are realized.
