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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.
Please make sure your experience as it relates to provider engagement leadership is included on your resume.
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..
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.
Pay Range: $59,810.6 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.