Health Plan Provider Relations Manager
location_onEquitable Building, 604, Locust Street, Downtown, Des Moines, Polk County, Iowa, 50309, United States
Job Description
About the Role
The Health Plan Provider Relations Manager serves as the primary point of contact between Molina Healthcare and contracted providers within the network. This role provides subject matter expertise and leadership for health plan provider relations activities, supporting network development, network adequacy, and provider training and education. The position is responsible for managing the provider network by ensuring provider education, communication, satisfaction, issue intake, access, and availability, while ensuring knowledge of and compliance with Molina policies and procedures.
This role requires a strategic partner who can engage high-priority, high-volume, and complex provider communities, including those involved in value-based payment (VBP) and alternative payment method (APM) contracts. The manager facilitates education on key Molina initiatives and improves coordination and partnership between the health plan and contracted providers. Additionally, the role serves as the primary liaison for the non-complex provider community, including fee-for-service (FFS) and pay-for-performance (P4P) providers.
Day in the Life
As a Provider Relations Manager, you will collaborate directly with external providers to educate, advocate, and engage them as valuable partners. You will ensure providers understand and comply with Molina policies while achieving high levels of customer service. Key daily activities include driving timely issue resolution, facilitating electronic medical record (EMR) connectivity, and promoting provider portal adoption.
You will resolve complex provider issues that may cross departmental lines, including contracting, finance, quality, and operations, often involving senior leadership. This involves conducting regular provider site visits within the assigned region or service area to meet monthly goals. During these visits, you will proactively engage with provider staff to determine compliance with Molina policies or Centers for Medicare and Medicaid Services (CMS) guidelines, and assess the non-clinical quality of customer service provided to members.
The role also involves independently troubleshooting provider problems, taking initiative to prevent and resolve issues between the provider and the plan. You will initiate and participate in problem-solving meetings with Molina stakeholders, including senior leadership and physicians, to address issues related to utilization management, pharmacy, quality of care, and correct coding. Furthermore, you will deliver training and presentations to assigned providers, their staff, and larger groups, such as leaders of multispecialty groups or health systems.
Culture and Values
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. We are committed to fostering an inclusive environment where diverse perspectives are valued. We offer a competitive benefits and compensation package to support our team members.
Application Note
Please update your resume with any relevant Behavioral Health or value-based experience. These qualifiers are important for this role.
Work location
Work model: Remote
Equitable Building, 604, Locust Street, Downtown, Des Moines, Polk County, Iowa, 50309, United States
Des Moines, Iowa
Key Responsibilities
- check_circleEngage strategic complex providers to ensure satisfaction and facilitate education on key initiatives
- check_circleServe as primary point of contact for non-complex provider community members
- check_circleCollaborate with external providers to ensure compliance with policies and procedures
- check_circleConduct regular provider site visits to assess compliance and customer service quality
- check_circleProvide on-the-spot training and counseling to providers diplomatically
- check_circleIndependently troubleshoot and resolve provider problems as they arise
- check_circleCoordinate problem-solving meetings between providers and Molina stakeholders
- check_circleOversee and demonstrate accountability for provider satisfaction survey results
- check_circleDevelop strategic network planning tools to drive provider relations and contracting strategy
- check_circleFacilitate strategic planning and documentation of network management standards
- check_circleProvide training, mentoring, and support to new and existing provider relations team members
- check_circleResolve complex provider issues crossing departmental lines including contracting and finance
Requirements
- verifiedAt least 6 years of provider services experience
- verifiedExperience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers
- verifiedExperience with Medicaid, Medicare, and/or Marketplace products
- verifiedStrong understanding of the health care delivery system, including government-sponsored health plans
- verifiedExperience with managed health care provider compensation methodologies (FFS, capitation, risk, ASO)
- verifiedPrevious experience with community agencies and providers
- verifiedStrong organizational skills and attention to detail
- verifiedAbility to manage multiple tasks and deadlines effectively
- verifiedExperience with preparing and presenting formal presentations
- verifiedStrong interpersonal skills
- verifiedAbility to work in a cross-functional highly matrixed organization
- verifiedStrong verbal and written communication skills
- verifiedMicrosoft Office suite and applicable software programs proficiency