Job Summary Bring your strong provider relationship development and provider training & education to this leadership role within our California health plan.
What you will do:
• Provide and develop standards and resources to help the Molina health plan successfully develop and refine cost effective and high quality strategic provider networks, establishing both internal and external long-term partnerships.
• Work collaboratively with health plan network management and operations teams and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives with an emphasis on developing and implementing standards, resources, tools and best practices sharing across the organization.
• Develop and deploy strategic network planning tools to drive provider services and contracting strategy across the organization. Facilitates planning and documentation of network management standards and processes for all line of business.
• Provide matrix team support including, but not limited to: New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services.
• Build and/or perform provider communication, training & education programs for internal staff, external providers, and other stakeholders.
• Ensure compliance with applicable company/plan business requirements including state/federal statutes, government sponsored program requirements, and network access standards.
• BA or BS Degree or commensurate/equivalent experience in provider services or contract network development and management in a managed healthcare setting.
• 7 years experience in managed healthcare administration.
• Experience demonstrating working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicare or Medicaid lines of business, including but not limited to: fee-for service, capitation and delegation models, and various forms of risk, ASO, agreements, etc.
Required License, Certification, Association
MA or MS preferred
10 years managed healthcare administration experience.
• Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals).
Preferred License, Certification, Association
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.
Apply on company website