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Molina Healthcare
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  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    - Tampa
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
    Apply Now
  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    - Miami
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
    Apply Now
  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    - Jacksonville
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
    Apply Now
  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
    Apply Now
  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    - Tallahassee
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
    Apply Now
  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    - Destin
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
    Apply Now
  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    - Saint Petersburg
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
    Apply Now
  • M

    Rep, Provider Relations HP (Reside in Pasco or Pinellas County)  

    Molina Healthcare
    - Orlando
    Apply Now
    JOB DESCRIPTION *****This role will support providers throughout Pasc... Read More
    JOB DESCRIPTION *****This role will support providers throughout Pasco & Pinellas County***** Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **Essential Job Duties** - Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Collaborates directly with the plan's external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption. - Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). - May provide training and support to new and existing provider relations team members as appropriate. - Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area) in N. Florida region **Required Qualifications** - At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - General understanding of the health care delivery system, including government-sponsored health plans. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications** - Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Experience delivering training and facilitating educational presentations. \#PJHPO \#LI-AC1 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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
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  • M

    Care Review Clinician (RN)  

    Molina Healthcare
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    JOB DESCRIPTION Job SummaryProvides support for clinical member servic... Read More
    JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes clinical service requests from members or providers against evidence based clinical guidelines. - Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. - Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. - Processes requests within required timelines. - Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. - Requests additional information from members or providers as needed. - Makes appropriate referrals to other clinical programs. - Collaborates with multidisciplinary teams to promote the Molina care model. - Adheres to utilization management (UM) policies and procedures. Required Qualifications - At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM). - Recent hospital experience in an intensive care unit (ICU) or emergency room. 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 Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
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  • M

    Clinical Pediatric Pharmacist (CPP)  

    Molina Healthcare
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      Job Summary Provides support and subject matter expertise for clinic... Read More

     

    Job Summary

    Provides support and subject matter expertise for clinical pediatric pharmacy services and support. Contributes to overarching clinical pediatric pharmacy strategy for optimization of clinical and medication-related health care outcomes, and quality cost-effective member care.

     

    Essential Job Duties
    • Provides clinical pediatric rounds support including examination of member medical records, comprehensive medication reviews, and communication with Health Care Services leadership and nurse case managers who provide outbound support to members and providers 
    • Support clinical case referrals from Health Care Services/nurse case managers through reviews of member medication profiles and applyingevidence-based medicine and national guidelines when creating recommendations for health care providers for optimization of member medication regimens.
    • Analyzes and reviews medication lists for potential patient safety issues, including drug interactions, suboptimal medication regimens, etc in both clinical pediatric rounds and clinical case referral support.
    • Promotes clinically appropriate prescribing practices based on evidence-based medicine and national guidelines through various modalities (provider/plan profiling, member drug profile reviews, medication protocols/criteria, and case-by-case interventions).
    • Conducts training as needed to Health Care Services leadership/nurse case managers on self-serve pharmacy resources (formulary lookup, pharmacy locator, etc) as well as articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed.
    • Researches, develops, and implements drug utilization and disease state management strategies and intervention techniques to deliver high quality, cost effective health care.
    • Assists Health Care services leadership and nurse case managers in coordination of care for pharmacy-related issues as nurse case managers provide the necessary outbound health plan service support to members, their caregivers, and providers.
    • Serves as a pediatric drug information resource to pharmacy staff, Health Plan Chief Medical Officer, and Health Plan Health Care Services/nurse case manager staff 
    • Reviews and analyzes clinical reports generated internally or through external Pharmacy Benefit Manager (PBM) to track general clinical trends in drug utilization and identify potential clinical trend issues to be addressed
    • Works with Healthcare Services team (e.g., data managers, care managers, etc.) on member-centered interdisciplinary teams.
    • Assists leadership in developing/updating policies and procedures, and implementing changes to comply with state and federal regulations.

     

    Required Qualifications
    • Doctor of Pharmacy (PharmD). Resident of Florida with active Florida License must be active and unrestricted in applicable state(s) of practice. 

    • Demonstrated knowledge and expertise in clinical pharmacology and disease management for pediatric populations. 

    • Clinical skills related to  pediatric pharmacy And demonstrated knowledge of best practices in clinical pediatric-related disease states. 

    • Current knowledge and expertise in clinical pharmacology and disease management.
    • Ability to present ideas and information concisely to varied audiences.
    • Knowledge of processes and systems, and ability to develop and deliver necessary training to departmental staff and internal customers.
    • Ability to develops and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies and vendors.
    • Proficiency in compiling data, creating reports and presenting information.
    • Ability to meet established deadlines.
    • Functions independently and manages multiple projects.
    • Excellent verbal and written communication skills.
    • Microsoft Office suite (including Excel), and applicable software program(s) proficiency.                                                                                                                      


     

    Preferred Qualifications

    • At least 3 years of experience in a Managed Care Pharmacy, Pharmacy Benefit Manager (PBM), or related healthcare organization (ie hospital, ambulatory care, etc) experience. 

    • Pediatric Pharmacy Specialty Certification (BCPPS®)

    • Completion of a PGY1 residency plus two (2) additional years of post-licensure practice

    • Completion of a specialty (PGY2) residency in pediatric pharmacy
    • Medicaid experience
    • Clinical skills or pharmacotherapy expertise for  clinical pediatric-related conditions and medications. 

    • Experience with team-based care.             

    #PJPharm

    #LI-AC1

    #HTF

    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

    Pay Range: $80,412 - $156,803.45 / ANNUAL
    *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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