Molina Healthcare Job - 32934488 | CareerArc
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Company: Molina Healthcare
Location: Oak Brook, IL
Career Level: Executive
Industries: Healthcare, Pharmaceutical, Biotech


Job Description
Job Summary
Molina Health Plan Provider Network Management and Operations 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 Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

The VP, Network Strategy and Services is responsible for the development and implementation of enterprise-wide initiatives and projects to support robust provider and member engagement in support of achieving positive operational and financial outcomes.
• Responsible for the continued development and enhancement of the Provider Network Management and Operations Department including the implementation of standard processes, policies and procedures.
• Work closely with the health plans leadership to ensure compliance with all Molina, regulatory and industry standards.
• Support and execute new health plan implementations, acquisitions and expansions in collaboration with the Business Development Team.
• Drive positive cultural changes with focus on coaching and development.
• Plans, organizes, staffs, and coordinates activities of the Provider Network Management and Operations Department.
• Works with staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to contain unit cost, improve member access and enhance Provider satisfaction enterprise wide.
• Develop a Standardized Provider Engagement “Tool Kit”, training program and deployment plan. Develop and implement approaches to determining outcomes of tools and training programs.
• Develop and oversee deployment strategy and monitoring for “Provider Profiles” and “Pay for Performance (P4P)” contracting.
• In conjunction with Provider Services and Provider Contracting leaders in the Health Plans and in collaboration with the MHI AVP of Provider Contracting identify, develop and implement approaches for performance management of Value Based Reimbursement.
• Develop and refine “Clear Coverage” provider adoption strategies and assist in training of health plan staff as Clear Coverage is implemented in each Plan.
• Represent Provider Engagement with Stakeholder Experience, Quality and RAMP business partners to ensure we incorporate the necessary plans to achieve positive operational and financial outcomes.
• Monitor key metrics to determine Provider Engagement effectiveness and success (e.g. Provider Appeals and Grievances, Member Appeals and Grievances, CAHPs, STAR Ratings, HEDIS, HEP Completion Rates, etc.)


Job Qualifications

Required Education
Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience
Required Experience
Minimum 10+ years of management and strong leadership experience. Minimum 5 years of healthcare, managed care, provider services and call center operations experience in government sponsored programs. Excellent interpersonal and communication skills (verbal and written). Excellent leadership and managerial skills. Proven record of accomplishments in work history.
Preferred Education
Master's Degree

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.

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