Lead, Health Plan Provider Relations & Contracting

Molina Healthcare; Kenosha (WI); On-site; USD 66,000 - 130,000; Full time

Job summary

Molina Healthcare in Wisconsin seeks a Provider Relations Manager to lead a team responsible for health plan provider relations, network development, contracting, and provider education. You will serve as the primary liaison between the Molina network and contracted providers.

You will work with network leadership to design strategies, oversee provider education programs, ensure compliance with Molina policies, and drive initiatives to improve member access, quality metrics, and cost management.

Qualifications

• At least 7 years of provider services experience across Medicaid, Medicare, and Marketplace products.
• At least 1 year of management/leadership experience.
• Strong understanding of the health care delivery system and government-sponsored plans.
• Experience with provider compensation methodologies (FFS, capitation, risk, ASO).
• Strong interpersonal and presentation skills; cross-functional collaboration.

Responsibilities

• Oversees the plan’s provider relations function and team members, including education, outreach and inquiry resolution.
• Develops provider relations strategies with network leadership to build a sufficient contracted network.
• Oversees provider representatives activities, including policy creation, training materials, and reports.
• Assists with provider network development and education of contracted providers on procedures and claims policies.
• Develops tracking tools to ensure timely issue resolution and compliance with provider relations standards.
• Ensures cross-department communication of provider relations initiatives and issues.

Skills

Provider relations leadership

Team management

Communication

Healthcare stakeholder liaison

Strategic planning

Tools

Microsoft Office Suite

Job description

Molina Healthcare in Wisconsin seeks a Provider Relations Manager to lead a team responsible for health plan provider relations, network development, contracting, and provider education. You will serve as the primary liaison between the Molina network and contracted providers.

You will work with network leadership to design strategies, oversee provider education programs, ensure compliance with Molina policies, and drive initiatives to improve member access, quality metrics, and cost management.