***Remote and must live in Illinois***

JOB DESCRIPTION

Job Summary

Develops and implements initiatives and projects supporting provider engagement. Responsible for continuous quality improvements. Supports robust provider engagement to achieve positive operational and financial outcomes.

KNOWLEDGE/SKILLS/ABILITIES

Leads one or more health plan Provider Engagement managers and their team(s) working with Strategic Providers to improve Quality outcomes and MCR. Establishes the strategy and operational direction for all Provider Engagement Team (PET) activity, in collaboration with the Plan President, COO and VP of Network Contracting. Coordinates and facilitates PET meetings, including meeting agendas, minutes, handouts, and monitoring action items to completion. Ensures health plan PET stakeholders are engaged and prepared to report quarterly updates at the meetings and overall, to health plan Senior Leadership Team meetings. May lead one or more teams from multiple disciplines (Quality, Provider Services, Clinical, Operations) to engage with key providers. Has overall responsibility for the content, maintenance, and access to the Health Plan PET SharePoint site. Collects, monitors, and disseminates PET reports. Builds internal relationships to develop a TEAM approach to Provider Engagement. Builds and nurture positive relationships between strategic providers and Plan. Reports on Strategic Provider results (e.g. changes in Quality outcomes, MCR, financial results, etc.) on periodic basis to Senior Leadership Team.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent provider contract network development & management, and project management experience, in a managed healthcare setting.

Required Experience

Min 7 years experience in managed healthcare administration and/or Provider Services. Min 7 years experience in provider contract negotiations in a managed healthcare setting. Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: fee-for service, capitation and various forms of risk, ASO, etc.

Preferred Education

Master's Degree

Preferred Experience

Experience negotiating different provider contract types, i.e. physician, group and hospital contracting, etc. Over 7 years customer service, provider service, or claims experience in a managed care setting.

Preferred License, Certification, Association

Valid State Driver's License

 

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.