Jobs
>
Seattle

    Provider Relations Manager - Seattle, WA, United States - Molina Healthcare

    Molina Healthcare
    Molina Healthcare Seattle, WA, United States

    2 weeks ago

    Default job background
    Description

    ***Remote and must live in Washington***

    Job Description

    Job Summary

    Molina Health Plan Network Provider Relations 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 Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

    Job Duties

    This role serves as the primary point of contact between Molina Health plan and the Plan's Complex Provider Community that services Molina members, including but not limited to Value Based Payment and other Alternative Payment Method contracts. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.


    • Under general supervision, works directly with the Plan's external complex providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service.


    • Resolves complex provider issues that may cross departmental lines including Contracting, Finance, Quality, Operations, and involve Senior Leadership.


    • Responsible for Provider Satisfaction survey results.


    • Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise.


    • Facilitates strategic planning and documentation of network management standards and processes. Effectiveness is tied to financial and quality indicators.


    • 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.


    • MCST matrix team environmental support including, but not limited to: New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services.


    • Serves as a subject matter expert for other departments.


    • Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.


    • Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.


    • Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.


    • Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.


    • Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's).


    • Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).


    • Trains other Provider Relations Representatives as appropriate.


    • Role requires 60%+ same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.)

    Job Qualifications

    REQUIRED EDUCATION:

    Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience.

    REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:


    • 4-6 years provider contract network relations and management experience in a managed healthcare setting.


    • Working experience servicing complex providers with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, value-based contracts, capitation and various forms of risk, ASO, etc.

    PREFERRED EDUCATION:

    Master's Degree in Health or Business related field

    PREFERRED EXPERIENCE:


    • 5 years experience in managed healthcare administration.


    • Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals).

    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.

    #PJCorp

    Pay Range: $54, $117,808.76 / ANNUAL
    *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

  • Molina Healthcare

    Provider Relations Manager

    4 days ago

    Molina Healthcare Seattle, United States

    Job Description · ***Remote and must live in Washington*** · Job Summary · Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core ...

  • LHH

    Labor Relations Manager

    2 weeks ago

    LHH Seattle, United States

    LHH Recruitment Solutions is hiring for an Labor Relations Manager for a large company located in Seattle, WA. This person will oversee the labor relations strategy, workforce planning and projects to include managing collective bargaining and ensuring compliance. · Responsibili ...

  • Heidelberg Materials US, Inc.

    Labor Relations Manager

    3 weeks ago

    Heidelberg Materials US, Inc. Seattle, United States

    AutoReqId: 19271BR · Pay Class: Salaried Exempt · Minimum Pay Rate: $125,580.00 · Maximum Pay Rate: $172,680.00 · Department: Human Resources · Line of Business: Corporate Administration (SSC, IT, Employee Services, Etc.) · Position Type: Full-Time · Job Posting: · The Role and t ...

  • Apex Systems

    Public Relations Manager

    2 weeks ago

    Apex Systems Seattle, United States

    PR Manager · 8 Month Contract · Hybrid - Tues - Thurs · Apex Systems is looking for a self-motivated and experienced public relations contractor for its Healthcare/Life Science Comms team. The purpose of this role is to drive awareness around the positive work Apex Systems does ...

  • LHH

    Labor Relations Manager

    1 week ago

    LHH Seattle, United States

    LHH Recruitment Solutions is hiring for an Labor Relations Manager for a large company located in Seattle, WA. This person will oversee the labor relations strategy, workforce planning and projects to include managing collective bargaining and ensuring compliance. · Find out mor ...

  • Heidelberg Materials US, Inc.

    Labor Relations Manager

    2 weeks ago

    Heidelberg Materials US, Inc. International, United States

    AutoReqId: 19271BR · Pay Class: Salaried Exempt · Department: Human Resources · Job Posting: · The Role and the Company · Heidelberg Materials provides the materials to build our future. Our future is sustainable. Our future is digital. And it goes way beyond cement, aggregates a ...

  • Heidelberg Materials

    Labor Relations Manager

    4 days ago

    Heidelberg Materials Seattle, United States

    Job Posting · The Role and the Company · Heidelberg Materials provides the materials to build our future. Our future is sustainable. Our future is digital. And it goes way beyond cement, aggregates and ready-mixed concrete. Heidelberg Materials North America, previously known a ...

  • Molina Healthcare

    Provider Relations Manager

    5 days ago

    Molina Healthcare Seattle, WA, United States

    ***Remote and must live in Washington*** · Job Summary · Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strat ...

  • LHH

    Labor Relations Manager

    3 weeks ago

    LHH Seattle, United States

    LHH has partnered with a prominent and growing company in the Seattle area in search of a Labor Relations Manager. This person will have a strong understanding of labor relations, strong negotiation skills, be organized and detail oriented. · What you will do: · Partner with Di ...

  • Lhh

    Labor Relations Manager

    6 days ago

    Lhh Seattle, United States

    1 week ago · Be among the first 25 applicants · Save this job with your existing LinkedIn profile, or create a new one. · Save this job with your existing LinkedIn profile, or create a new one. · Your job seeking activity is only visible to you. · Email · Welcome back · Sign ...

  • Apex Systems

    Public Relations Manager

    2 weeks ago

    Apex Systems Seattle, United States

    Public Relations Manager (Health-Tech) · Job ID: · Location: Seattle, Washington DC, San Francisco or New York City (on-site 3 days/week) · Travel: Mandatory travel to media events in Washington DC 6/24 - 6/27, New York 7/10, and Vegas 10/20 - 10/23 · Target Start date: May 2024 ...

  • Lehigh Hanson

    Labor Relations Manager

    3 weeks ago

    Lehigh Hanson Seattle, United States

    Search for Job Title, Keywords, Military Job Title or Code · {{ }} · Search for City, State, Country, Zip Code · {{ result.location }} · Miles: · For more than a century, Heidelberg Materials has been a leading supplier of cement, aggregates, ready mixed concrete, asphalt an ...

  • Alaska Airlines

    Manager Employee Relations

    1 week ago

    Alaska Airlines Seattle, United States

    Company: · Alaska Airlines · The Team: · Guided by our purpose, core values, and leadership principles, we are creating an airline people love. Our corporate teams set the strategies and operational plans to ensure the success of our company. Whether we use our expertise in acco ...

  • Heidelberg Materials

    Labor Relations Manager

    3 weeks ago

    Heidelberg Materials Seattle, United States

    Job Posting · The Role and the Company · Heidelberg Materials provides the materials to build our future. Our future is sustainable. Our future is digital. And it goes way beyond cement, aggregates and ready-mixed concrete. Heidelberg Materials North America, previously known as ...

  • Alaska Airlines

    Manager Employee Relations

    3 weeks ago

    Alaska Airlines Seattle, United States

    Company: · Alaska Airlines · The Team: · Guided by our purpose, core values, and leadership principles, we are creating an airline people love. Our corporate teams set the strategies and operational plans to ensure the success of our company. Whether we use our expertise in ac ...

  • LHH

    Labor Relations Manager

    3 weeks ago

    LHH Seattle, United States

    LHH has partnered with a prominent and growing company in the Seattle area in search of a Labor Relations Manager. This person will have a strong understanding of labor relations, strong negotiation skills, be organized and detail oriented. · What you will do: · Partner with Dir ...

  • ROCKWOOL International A/S

    Labour Relations Manager

    3 weeks ago

    ROCKWOOL International A/S Seattle, United States

    We are seeking a Labour Relations Manager based in our Grand Forks, BC location to join the Human Resources team. · Generous relocation package is offered · Ready to help build a better future for generations to come? · In an ever-changing, fast paced world, we owe it to ourselve ...

  • Seattle Children's

    Manager, Public Relations

    2 weeks ago

    Seattle Children's Seattle, United States

    Responsibilities: Develop, implement and manage a broad range of public relations and media programs that increase public awareness and understanding and that positions Seattle Children's as regional and national center of excellence for pediatric care. Manage, lead, and evaluate ...

  • GenCare Lifestyle

    Community Relations Manager

    1 week ago

    GenCare Lifestyle Seattle, United States

    Job Description · Job Description Description: · Description · GenCare Lifestyle @ The Ballard Landmark in Seattle is a Premier Senior · Independent/Assisted · Living community and a recent US News & World Report Community Award Winner for Best Assisted Living. · We are curre ...

  • Apex Systems

    Public Relations Manager

    2 weeks ago

    Apex Systems Seattle, United States

    Public Relations Manager (Health-Tech) · Job ID: · 2016102 · Location: · Seattle, Washington DC, San Francisco or New York City (on-site 3 days/week) · Travel: · Mandatory travel to media events in Washington DC 6/24 - 6/27, New York 7/10, and Vegas 10/20 - 10/23 · Target Star ...