Manager Provider Services

Company: Molina Healthcare Inc.
Location: Long Beach
Posted on: September 21, 2022

Job Description:

Job Description

Job Summary

Develops and implements enterprise-wide initiatives and projects supporting provider engagement. Responsible for continuous quality improvements. Supports robust provider engagement to achieve positive operational and financial outcomes.

Knowledge/Skills/Abilities

* Leads and facilitates multidisciplinary Provider Engagement Teams (PETs) working with key strategic provider partners to improve quality outcomes and Medical Care Ratios (MCR) in support of business objectives.
* Serves as a Provider Engagement internal consultant and subject matter expert; works collaboratively to ensure the PETs and their initiatives are supported by effective, accurate and efficient business processes. Identifies and initiates continuous quality improvements regarding provider engagement.
* Develops and implements efficiency measures that are consistent and supportive of the strategic plans. Develops, tracks and reports key performance measures.
* Supports, educates and equips strategic providers with information and tools for success; provides practice management resources and assistance. Addresses challenges/barriers in the practice environment impeding successful attainment of program goals.
* Facilitates and actively participates in program discussions and activities with internal and external providers.
* Oversees/develops and coordinates with internal stakeholders the PET meeting agendas, minutes and handouts; monitors action items to completion. Ensures stakeholders are engaged and prepared to report updates at regularly scheduled PET meetings.
* Responsible for maintaining the PET SharePoint site. Accountable for document creation and maintenance.
* Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
* Communicates comfortably and effectively with all levels of a healthcare organization, within both the corporate and regional market environments..

Job Qualifications

Required Education

Bachelor's degree in Business, Healthcare, Nursing or related field or equivalent combination of education and relevant experience

Required Experience

* Min 5 years experience in managed healthcare administration and/or Provider Services.
* Min 5 years experience in provider contract negotiations in a managed healthcare setting.
* Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: fee-for service, capitation and various forms of risk, ASO, etc.

Preferred Education

Master's Degree

Preferred Experience

* Experience negotiating different provider contract types, i.e. physician, group and hospital contracting, etc.
* Over 5 years customer service, provider service, or claims experience in a managed care setting.

Preferred License, Certification, Association

Valid State Driver's License

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Keywords: Molina Healthcare Inc., Long Beach , Manager Provider Services, Executive , Long Beach, California