Molina Healthcare Provider Network Manager-Remote-Must reside in Illinois in Oak Brook, Illinois
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 Network staff are the primary point of contact between Molina Healthcare and provider network and are responsible for end-to-end relationship and management. They are responsible for provider contracting, provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.
Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Network functions with an emphasis on contracting, education, outreach and resolving provider inquiries.
• In conjunction with the Director, Provider Network Management & Operations, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
• Targets and recruits additional providers to reduce member access grievances.
• Develops and deploys strategic network planning tools to drive Provider Services and Contracting Strategy across the enterprise.
• Facilitates strategic planning and documentation of network management standards and processes.
• Works collaboratively with functional business unit stakeholders to lead and/or support various provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization.
• Assesses contract language for compliance with corporate standards and regulatory requirements and review revised language with assigned MHI attorney.
• Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal.
• Educates internal customers on provider contracts.
Bachelor's Degree in Health or Business related field or equivalent experience.
• 5 years provider contract network development and management experience in a managed healthcare setting.
• Project management experience.
• Working familiarity with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, capitation and various forms of risk, ASO, etc.
Master's Degree in Health or Business related field
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.