Strategic Provider Relations Manager (Health Plan)

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

Job summary

Molina Healthcare is seeking a Provider Relations professional in Illinois to lead education and engagement for contracted providers, manage network development and provider training, and ensure policy compliance across Medicaid, Medicare and Marketplace products.

The role requires strong interpersonal and presentation skills, the ability to navigate a matrix organization, and frequent travel to provider sites to meet objectives and improve provider satisfaction.

Qualifications

• At least 6 years of provider services experience across Medicaid, Medicare, and Marketplace lines.
• Strong understanding of the health care delivery system and government-sponsored health plans.
• Experience with provider compensation methodologies (FFS, capitation, risk, ASO).
• Experience interfacing with providers and medical staff; ability to present and educate.

Responsibilities

• Engage high-priority, high-volume provider communities and ensure satisfaction with Molina initiatives.
• Serve as primary contact between Molina and contracted providers; support education and portal adoption.
• Educate, advocate and partner with external providers while ensuring policy compliance and customer service.
• Resolve cross-department issues involving contracting, finance, quality, and operations; coordinate with senior leadership.
• Conduct provider site visits and coordinate schedules to meet monthly goals; assess non-compliance with policies and CMS guidelines.
• Provide on-the-spot training and presentations to providers and staff; mentor new provider relations team members.
• Travel 60%+ as required to support regional/provider needs and provider engagement.

Skills

Interpersonal skills

Organizational skills

Communication skills

Attention to detail

Time management

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a Provider Relations professional in Illinois to lead education and engagement for contracted providers, manage network development and provider training, and ensure policy compliance across Medicaid, Medicare and Marketplace products.

The role requires strong interpersonal and presentation skills, the ability to navigate a matrix organization, and frequent travel to provider sites to meet objectives and improve provider satisfaction.