Manager, National Provider Services
$31,200–$31,200 year
RemoteUnited States
Job Summary
Lead and manage the national provider services team, overseeing enterprise network management, operations, and provider training. Drive provider education, outreach, and inquiry resolution while ensuring compliance with Molina policies and procedures. Develop strategic network planning tools, standards, and resources to refine cost-effective provider networks and establish long-term partnerships. Manage provider contracting strategies, resolve issues regarding claims, eligibility, and reimbursement, and implement tracking tools for timely issue resolution. Build and nurture relationships with contracted providers, hospitals, and ancillary facilities to support health plan initiatives and quality programs.
Required Qualifications
- At least 7 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and or Marketplace products, or equivalent combination of relevant education and experience
- At least 1 year of management/leadership experience
- Strong understanding of the health care delivery system, including government-sponsored health plans
- Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.
- Previous experience with community agencies and providers
- Strong organizational skills and attention to detail
- Ability to manage multiple tasks and deadlines effectively
- Strong interpersonal skills, including ability to interface with providers and medical office staff
- Experience with preparing and presenting formal presentations
- Project management experience
- Ability to work in a cross-functional highly matrixed organization
- Strong verbal and written communication skills
- Microsoft Office suite and applicable software programs proficiency
Desired Qualifications
- Contract negotiation experience
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