Senior Representative, Health Plan Provider Relations-Las Vegas, Nevada

Molina Healthcare•Long Beach, CA

About The Position

Provides senior level support for network development, network adequacy, and provider training and education in alignment with Molina Healthcare’s mission and regulatory requirements. Serves as the primary point of contact for high-priority and complex providers. Manages complex network relationships, facilitates contracting and issue resolution, and promotes provider engagement and compliance while delivering exceptional service and communication.

Requirements

At least 4 years of customer or provider service experience in a managed care setting.
At least 3 years of managed healthcare administration and/or provider services experience, or equivalent education and experience.
Working knowledge of managed healthcare provider compensation methodologies across Medicaid, Marketplace, and Medicare, including fee-for-service, capitation, and risk-based models.
Excellent relationship management, communication, and interpersonal skills.
Skilled in interpreting and drafting contract language and resolving provider issues collaboratively.
Strong organizational skills and ability to manage multiple priorities with minimal supervision.

Nice To Haves

Experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals)

Responsibilities

Acts as the primary liaison between Molina Healthcare and high-volume or complex providers, including those under fee-for-service and pay-for-performance programs.
Engages provider leadership and physicians to strengthen partnerships and improve provider satisfaction.
Resolves complex issues, ensuring timely communication and resolution across multiple departments.
Negotiates and manages provider Letters of Agreement, contracts, and amendments through full execution using approved templates.
Serves as a subject matter expert for provider contracting and maintains contracts within contract management systems.
Supports network development through provider research, recruitment, and negotiation.
Clearly communicates contract terms, payment structures, and reimbursement models to providers.
Analyzes and coordinates amendments, reimbursement structures, and contract language changes.
Conducts regular provider site visits to ensure compliance, assess satisfaction, and deliver training.
Provides education, counseling, and orientation to contracted providers and staff, maintaining positive relationships.
Independently troubleshoots provider issues and escalates when necessary.
Develops and delivers presentations to provider offices, leadership teams, and professional associations.
Promotes Molina initiatives focused on administrative efficiency, quality improvement, and member satisfaction such as Consumer Assessment of Healthcare Providers and Systems (CAHPS).
Trains and mentors other Provider Relations Representatives as needed.
Maintains tracking systems and reports according to departmental standards.
Supports regulatory audits, special projects, and provider data updates.
May require same-day or overnight travel based on plan needs.