Jobs
>
Cayce

    Manager, Provider Relations - Cayce, United States - Molina Healthcare

    Molina Healthcare
    Molina Healthcare Cayce, United States

    2 weeks ago

    Default job background
    Description

    _Remote and must live in South Carolina
    _

    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. In partnership with Director, manages and coordinates the Provider Services activities for the state health plan. Works with direct management, corporate, and staff to develop and implement standardized provider servicing and relationship management plans.


    Job Duties
    Manages the Plan's Provider Relations functions and team members.

    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 Services functions with an emphasis on contracting, education, outreach and resolving provider inquiries.


    • In conjunction with the Director, Provider Network Management & Operations, develops health planspecific provider contracting strategies, identifying specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members.
    • Oversees and leads the functions of the external provider representatives, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards.
    • Manages and directs the Provider Service staff including hiring, training and evaluating performance.
    • Assists with ongoing provider network development and the education of contracted network providers regarding plan procedures and claim payment policies.
    • Develops and implements tracking tools to ensure timely issue resolution and compliance with all applicable standards.
    • Oversees appropriate and timely intervention/communication when providers have issues or complaints (e.g., problems with claims and encounter data, eligibility, reimbursement, and provider website).
    • Serves as a resource to support Plan's initiatives and help ensure regulatory requirements and strategic goals are realized.
    • Ensures appropriate crossdepartmental communication of Provider Service's initiatives and contracted network provider issues.
    • Designs and implements programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and Plan.
    • Develops and implements strategies to increase provider engagement in HEDIS and quality initiatives.
    • Engages contracted network providers regarding cost control initiatives, Medical Care Ratio (MCR), nonemergent utilization, and CAHPS to positively influence future trends.
    • Develops and implements strategies to reduce member access grievances with contracted providers.
    • Oversees the IHH program and ensures IHH program alignment with department requirements, provider education and oversight, and general management of the IHH program

    Job Qualifications

    REQUIRED EDUCATION :

    Bachelor's Degree in Health or Business related field or equivalent experience.


    REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

    • 5-7 years experience servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products
    • 5+ years previous managed healthcare experience.
    • Previous experience with community agencies and providers.
    • Experience demonstrating working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicare or Medicaid lines of business, including but not limited to: feefor service, valuebased contracts, capitation and delegation models, and various forms of risk, ASO, agreements, etc.
    • Experience with preparing and presenting formal presentations.
    • 2+ years in a direct or matrix leadership position
    • Min. 2 years experience managing/supervising employees.

    PREFERRED EDUCATION :

    Master's Degree in Health or Business related field


    PREFERRED EXPERIENCE :


    • 57 years managed healthcare administration experience.
    • 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.

    Pay Range:
    $59, $129,589.63 / ANNUAL

    *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
  • Prisma Health

    provider relations coordinator

    1 week ago

    Prisma Health Columbia, SC , USA, United States

    Inspire health. Serve with compassion. Be the difference. · Job Summary · The Provider Relations Coordinator - CIN is accountable for the overall client/member services, communications, and engagement of the provider/physician practices in the region and is the direct interface b ...

  • Horizon Innovations

    Working Student

    1 week ago

    Horizon Innovations Cayce, United States

    At C&A Services, we are the international IT service provider for all C&A companies. Based in Düsseldorf, we support the retail industry by providing IT services and developing IT solutions on an international level for C&A in Europe. To strengthen our Supply Chain Development te ...

  • Authority Brands

    Benefits Specialist

    2 weeks ago

    Authority Brands Columbia, United States

    We are looking for a dynamic **Benefits Specialist** to add to our growing Benefits team. The Benefits Specialist is responsible for assisting with the administration of all benefits and retirement programs, including medical, dental, vision, life insurance, short · - and long-te ...

  • FEI Systems

    Service Desk Associate

    1 week ago

    FEI Systems Columbia, United States

    At FEI Systems, we create innovative technology solutions to improve the delivery of health and human services because we know when cumbersome administrative processes stand in the way, those who need it most are often left without access to proper care and support. From comprehe ...

  • Dartpoints Operating Company

    Noc Technician I

    1 week ago

    Dartpoints Operating Company Columbia, United States

    **Position Summary**: · The NOC Technician I primary role is to provide 24x7 Monitoring of Customer and DartPoints specific alerts, technical customer support to clients, and provide internal support to NOC team members. · **This is NOT a remote position.** · **Primary Responsibi ...

  • C-HIT

    Appeals Specialist I

    2 weeks ago

    C-HIT Columbia, United States

    **Position Overview**: · **Key Responsibilities**: · - 1. Taking Phones: · - Professionally handle incoming phone calls from providers/suppliers. · - Address inquiries, provide information, and escalate issues as needed. · 2. Call Logs Entries: · - Accurately log all phone intera ...

  • 1Rivet

    Corporate Real Estate

    3 days ago

    1Rivet Columbia, United States

    GENERAL SUMMARY/JOB PURPOSE: · The CRE Project Manager provides a wide range of administrative and technical project tasks overseeing design, engineering, construction, renovations, commissioning and auditing operational systems. Serves as Owner's Representative for project manag ...

  • Howard County

    Human Services Specialist I

    1 day ago

    Howard County Columbia, United States

    **Howard County** · Conveniently located in the heart of central Maryland between Baltimore and Washington, Howard County offers the charm of a historic past mixed with the excitement of a cosmopolitan community. · **Howard County Government** · Howard County Government is a lead ...

  • Havtech LLC

    Customer Service Representative

    1 week ago

    Havtech LLC Columbia, United States

    The Warranty Specialist is responsible for all aspects of customer support related to warranty administration through responding to customer inquiries, answering questions regarding Commercial Distribution services, and managing the warranty claims process. · **ESSENTIAL DUTIES A ...

  • Capital One

    Area Sales Manager

    3 days ago

    Capital One Columbia, United States

    Locations: Sales - SC - Columbia, United States of America, Columbia, South CarolinaArea Sales ManagerAs a Digital Sales Consultant for Capital One Auto Finance, you will partner closely with a defined set of Automobile Dealerships, providing consultative guidance to help each de ...

  • Johns Hopkins University

    Patient Service Coordinator

    1 day ago

    Johns Hopkins University Columbia, United States

    We are seeking a**_ Patient Service Coordinator_** who will offer friendly, courteous, and confidential assistance to every patient to ensure that the patient has a positive experience while at Johns Hopkins. Coordinate the day-to-day clinical operations for a group of health car ...

  • HUMANIM INC

    Technician, Behavioral Info Session

    2 weeks ago

    HUMANIM INC Columbia, United States

    The Behavior Technician will provide clinical skills instruction and behavior reduction strategies based upon the principles of Applied Behavior Analysis to children with Autism in a school and center-based setting. The Behavior Technician will collect data on programs, and assis ...

  • Johns Hopkins University

    Co Medical Office Coordinator

    2 weeks ago

    Johns Hopkins University Columbia, United States

    The Department of Psychiatry and Behavioral Sciences is seeking a **_CO Medical office Coordinator_** to coordinate activities and provides secretarial support for a multi-faceted clinical/research office to ensure a smoothly functioning office and good patient relations. Interac ...

  • Booth Management Consulting

    Proposal Editor/writer Support

    2 weeks ago

    Booth Management Consulting Columbia, United States

    Booth Management Consulting, LLC (BMC) is a diverse CPA firm providing accounting, auditing, and management consulting services to public and private clients nationwide. With an employee-friendly company environment that emphasizes quality of life, initiative, creativity, strong ...

  • Home Care Solutions

    Occupational Therapist

    6 days ago

    Home Care Solutions Columbia, United States Full time

    The Occupational Therapist in Home Health is responsible for the assessment and evaluation of patient care needs related to functional status, activities of daily living, fine motor coordination, home assessments and adaptive equipment, and other occupational therapy needs as def ...

  • Absolute Business Solutions Corp

    Human Resources Support Specialist

    1 week ago

    Absolute Business Solutions Corp Columbia, United States

    **Position Summary**: · **Responsibilities Include, But Are Not Limited To**: · - Provide customer service support for all S-1 functions and duties · - Assist the S-1 in integrating HR support into unit operations · - Assist the S-1 in ensuring HR core competencies and key functi ...

  • Richland County Government

    Detention Officer

    1 week ago

    Richland County Government Richland County, SC, United States

    The purpose of this class is to provide for the safety of staff and inmates and the security of the Detention Center; to supervise inmate activities; and to perform related corrections and law enforcement work as assigned. This class works according to some procedures but decides ...

  • MidPoint Technology Group

    Low Voltage Construction Safety Manager

    1 week ago

    MidPoint Technology Group Columbia, United States

    **MTG Overview**: · MidPoint Technology Group is a National Technology Integration Company primarily operating throughout the DMV. Our system solutions include Data Center, Audio-Visual, Electronic Security, Structured Cabling and IT-Wireless Services. We are looking for a Safety ...

  • Howard County

    Hcpd Crime Analyst

    1 week ago

    Howard County Columbia, United States

    **Howard County** · Conveniently located in the heart of central Maryland between Baltimore and Washington, Howard County offers the charm of a historic past mixed with the excitement of a cosmopolitan community. · **Howard County Government** · Howard County Government is a lead ...

  • SCS Engineers

    Entry-level Field Technician

    4 days ago

    SCS Engineers Columbia, United States

    **What we are looking for** · A Field Technician operates, monitors and maintains gas migration control/recovery systems including gas well monitoring and adjustment, troubleshooting, and system repairs. We are looking for a Field Technician to service the Columbia, MD area. · ** ...