at Molina Healthcare in Charleston, Illinois, United States Job Description

JOB DESCRIPTION

Employee for this role will support providers in Central & Southern IL

• Job Summary Provides subject matter expertise and leadership for health plan provider relations activities.

Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. Essential Job Duties

• Successfully engages the plan's highest priority, high-volume and strategic complex provider community providers (including value-based payment ( VBP ) and other alternative payment method ( APM ) contracts to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
• Serves as the primary point of contact between Molina health plan and the for non-complex provider community that services Molina members, including but not limited to fee-for-service ( FFS ) and pay-for-performance (P4P) providers.
• Collaborates directly with the plan's external 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; effectively drives timely issue resolution, electronic medical record ( EMR ) connectivity, and provider portal adoption.
• Resolves complex provider issues that may cross departmental lines including contracting, finance, quality, operations, and may involve senior leadership.
• Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals.

Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services ( 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, including counseling providers diplomatically, while retaining a positive working relationship.
• Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving To view full details and how to apply, please login or create a Job Seeker account