Job Description

Outcome-Based Summary:

Provides subject matter expertise and leadership for health plan provider relations activities. Represents as a key liaison between Molina its contracted network providers, ensuring effective partnerships that support access, quality, and member satisfaction. Provides subject matter expertise in network development, adequacy, and provider training and education. Responsible for provider engagement, contract negotiation, issue resolution, and education activities, while ensuring compliance with all applicable federal, state, and local regulations.

Job Duties:

• Serves as the primary point of contact between Molina and contracted providers within the health plan’s service area.
• Functions as an external-facing, field-based representative, building trusted relationships with providers, including senior executives and physicians, to drive satisfaction and partnership.
• Educates, advocates, and engages providers independently, ensuring alignment with Molina initiatives and performance expectations.
• Maintains accurate provider tracking systems, reports, and documentation in accordance with departmental procedures.
• Initiates, negotiates, and manages provider contracts, amendments, and Letters of Agreement from draft to execution using standardized templates.
• Negotiates contract language and rates for various provider types, including ancillary and behavioral health providers, ensuring alignment with corporate standards and compliance requirements.
• Acts as the contract system lead, maintaining contract data within the contract management software.
• Recruits and contracts new providers to address network gaps, enhance member access, and support adequacy standards.
• Clearly communicates contract terms, payment structures, and reimbursement rates to providers.
• Analyzes and coordinates amendments and reimbursement changes; gathers billing and service data to complete contract profiles.
• Coordinates the contracting process end-to-end, ensuring timely execution and compliance with internal standards.
• Resolves complex provider issues that may cross departments (e.g., contracting, finance, quality, operations) and require senior-level collaboration.
• Addresses and resolves provider satisfaction gaps identified in survey results.
• Leads and supports Provider Services initiatives, contributing to process improvements and sharing best practices across the organization.
• Serves as a subject matter expert to internal teams and cross-functional partners.
• Conducts regular provider site visits, ensuring compliance with Molina policies, assessing service quality, and providing real-time training and education as needed.
• Provides on-the-spot coaching and orientation during site visits, maintaining positive working relationships while addressing compliance or performance issues.
• Troubleshoots provider problems, escalating to appropriate departments as needed, and proactively prevents recurrence through provider education and process alignment.
• Coordinates and facilitates problem-solving meetings between providers and internal stakeholders, including senior leaders and clinicians, to resolve complex operational or clinical issues.
• Develops and delivers training sessions and presentations to provider offices, large medical groups, and health systems on Molina policies, programs, and quality initiatives.
• Promotes and educates providers on Molina initiatives such as Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), administrative efficiency, and quality programs.
• Provides training, mentoring and support to new and existing provider relations team members.
• Supports regulatory audits, provider roster updates, and inbox management for contracting activities.
• Participates in special projects and initiatives that advance provider satisfaction, network performance, and compliance.
• Requires same-day and occasional overnight travel depending on health plan geography.

Job Requirements:

• At least 6 years provider contracting, network and provider relations and management experience in a managed healthcare setting, or equivalent combination of relevant education and experience.
• Proven experience working with diverse provider types (e.g., physicians, hospitals, ancillary providers).
• Demonstrated proficiency in managed care compensation methodologies, including fee-for-service, value-based contracting, capitation, ASO agreements, and various forms of risk.
• Strong relationship management and negotiation skills.
• Skilled in interpreting, drafting, and negotiating contract language and reimbursement structures.
• Experienced in problem-solving and issue resolution.
• Ability to manage multiple priorities with minimal supervision in a fast-paced, highly regulated environment.
• Ability to work cross-functionally in a highly matrixed environment.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications:

• Specific experience in provider services, operations, or contract negotiations within a Medicare, Marketplace, and Medicaid managed health care setting.
• Experience working with multiple provider types, including physician groups, hospitals, and ancillary providers.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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