Strategic Provider Relations & Contracting Lead

Molina Healthcare; Milwaukee (WI); On-site; USD 110,000 - 150,000; Full time

Job summary

Molina Healthcare in Wisconsin seeks an experienced Provider Relations Leader to guide a team and shape the provider network strategy within the Molina network. You will educate providers, coordinate outreach, and resolve issues in partnership with corporate network teams.

The role emphasizes strategic engagement with contracted providers across Medicaid, Medicare, and Marketplace products, ensuring regulatory compliance and high-quality service delivery.

Qualifications

• 7+ years of provider services experience including Medicaid, Medicare and Marketplace exposure.
• At least 1 year of management/leadership experience.
• Strong understanding of the healthcare delivery system and government-sponsored plans.
• Experience with provider compensation methodologies (FFS, capitation, risk, ASO).
• Experience presenting formal presentations and interfacing with providers.

Responsibilities

• Oversees the plan's provider relations function and team members, handling daily operations.
• Develops health plan-specific provider relations strategies with leadership to expand the network.
• Leads provider representatives activities, policies, training materials, and reports.
• Educates contracted providers on plan procedures and claims payment policies.
• Implements tracking tools to ensure timely issue resolution and compliance.
• Manages provider interactions for claims, eligibility, reimbursement, and website issues.
• Drives cross-departmental communication and regulatory alignment; supports strategic goals.

Skills

Provider services experience

Management leadership

Healthcare delivery knowledge

Communication skills

MS Office proficiency

Tools

Microsoft Office

Job description

Molina Healthcare in Wisconsin seeks an experienced Provider Relations Leader to guide a team and shape the provider network strategy within the Molina network. You will educate providers, coordinate outreach, and resolve issues in partnership with corporate network teams.

The role emphasizes strategic engagement with contracted providers across Medicaid, Medicare, and Marketplace products, ensuring regulatory compliance and high-quality service delivery.