JOB DESCRIPTION
Job Summary
Molina 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.
KNOWLEDGE/SKILLS/ABILITIES
The VP, Marketplace Network Strategy and Services is responsible for the development and implementation of enterprise-wide initiatives that deliver a cost competitive, high quality network which supports positive operational and financial outcomes.
- Design successful network strategies for each state which contemplate competitor positioning, product strategies and each health plan’s goals across all Molina product lines. Successful strategies contain unit cost, broaden member access, improve network quality and enhance provider satisfaction
- Work closely with the health plans’ leadership to ensure the implementation these network strategies, including maintaining compliance with all Molina, regulatory and industry standards
- Develop, and oversee deployment of, Molina’s Marketplace value based care strategies
- Design, maintain and implement Molina’s proprietary Marketplace fee schedule
- Support and execute new health plan implementations, acquisitions, and expansions in collaboration with the Business Development Team
- Coordinates with health plans to develop and deploy a Standardized Provider Engagement “Tool Kit” and training program, that supports the overall Marketplace network strategy
- 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.).
- Responsible for the continued development and enhancement of the Marketplace Provider Network Management and Operations Department including the implementation of standard processes, policies, and procedures
- Drive positive cultural changes with focus on coaching and development.
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.
150 jobs found