Strategic Provider Relations Lead – Health Plan

Molina Healthcare; Marion (IL); On-site; USD 63,000 - 124,000; Full time

Job summary

Molina Healthcare is seeking an experienced Provider Relations Lead to support Central & Southern Illinois providers. You will drive network development, provider education, and satisfaction initiatives while serving as the main liaison between Molina and contracted providers.

The role requires 60%+ travel, strong understanding of Medicaid/Medicare provider payment models, and the ability to lead cross-functional collaboration across organizational boundaries.

Qualifications

• At least 6 years of provider services experience across Medicaid/Medicare/Marketplace.
• Strong understanding of the health care delivery system, including government-sponsored health plans.
• Experience with provider compensation methodologies across Medicaid and Medicare (FFS, capitation, risk).
• Experience with community agencies and providers.
• Strong organizational skills and attention to detail.
• Ability to manage multiple tasks and deadlines effectively.
• Experience with preparing and presenting formal presentations.
• Strong interpersonal skills and ability to interface with providers and medical office staff.
• Experience working in a cross-functional, matrixed organization.

Responsibilities

• Engage top-priority provider groups (including value-based contracts) to ensure satisfaction and educate on Molina initiatives.
• Serve as primary contact between Molina and non-complex provider communities.
• Collaborate with external providers to educate, advocate and ensure compliance with Molina policies.
• Resolve complex provider issues crossing departments; involve senior leadership when needed.
• Conduct regular provider site visits and plan visits to meet monthly goals.
• Provide on-the-spot training and education to providers and staff.
• Troubleshoot provider problems and prevent issues between providers and the plan.
• Lead problem-solving meetings with Molina stakeholders, including senior leadership and physicians.
• Deliver training/presentations to providers and larger groups (multispecialty groups, health systems, JOCs).
• Monitor and enforce policies; promote participation in Molina initiatives (CAHPS, EMR, portals).
• Oversee provider satisfaction survey results and drive improvements.
• Develop network planning tools to guide contracting strategy.
• Document network management standards and processes across the enterprise.
• Collaborate with business units to share best practices in provider services.
• Navigate matrix teams to support new markets and national contract management.

Skills

Provider relations

Medicare/Medicaid knowledge

Contract negotiation

Leadership experience

Presentation skills

Interpersonal skills

Cross-functional collaboration

Microsoft Office

Travel 60%+

Relationship building

Tools

Microsoft Office

Job description

Molina Healthcare is seeking an experienced Provider Relations Lead to support Central & Southern Illinois providers. You will drive network development, provider education, and satisfaction initiatives while serving as the main liaison between Molina and contracted providers.

The role requires 60%+ travel, strong understanding of Medicaid/Medicare provider payment models, and the ability to lead cross-functional collaboration across organizational boundaries.