Manager, Provider Relations HP (Washington Healthplan)

Job Description This role will support Providers in the state of Washington Job Summary Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. In partnership with Director, manages and coordinates the Provider Services activities for the state health plan. Works with direct management, corporate, and staff to develop and implement standardized provider servicing and relationship management plans. Job Duties Manages the Planu2019s Provider Relations functions and team members. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Services functions with an emphasis on contracting, education, outreach and resolving provider inquiries. u2022 In conjunction with the Director, Provider Network Management & Operations, develops health plan-specific provider contracting strategies, identifying specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members. u2022 Oversees and leads the functions of the external provider representatives, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards. u2022 Manages and directs the Provider Service staff including hiring, training and evaluating performance. u2022 Assists with ongoing provider network development and the education of contracted network providers regarding plan procedures and claim payment policies. u2022 Develops and implements tracking tools to ensure timely issue resolution and compliance with all applicable standards. u2022 Oversees appropriate and timely intervention/communication when providers have issues or complaints (e.g., problems with claims and encounter data, eligibility, reimbursement, and provider website). u2022 Serves as a resource to support Planu2019s initiatives and help ensure regulatory requirements and strategic goals are realized. u2022 Ensures appropriate cross-departmental communication of Provider Serviceu2019s initiatives and contracted network provider issues. u2022 Designs and implements programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and Plan. u2022 Develops and implements strategies to increase provider engagement in HEDIS and quality initiatives. u2022 Engages contracted network providers regarding cost control initiatives, Medical Care Ratio (MCR), non-emergent utilization, and CAHPS to positively influence future trends. u2022 Develops and implements strategies to reduce member access grievances with contracted providers. u2022 Oversees the IHH program and ensures IHH program alignment with department requirements, provider education and oversight, and general management of the IHH program u2022 Approximately 10-20% travel, mostly daytime, thoughout the state of Washington Job Qualifications REQUIRED EDUCATION : Bachelor's Degree in Health or Business related field or equivalent experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES : u2022 5-7 years experience servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products u2022 5+ years previous managed healthcare experience. u2022 Previous experience with community agencies and providers. u2022 Experience demonstrating working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicare or Medicaid lines of business, including but not limited to: fee-for service, value-based contracts, capitation and delegation models, and various forms of risk, ASO, agreements, etc. u2022 Experience with preparing and presenting formal presentations. u2022 2+ years in a direct or matrix leadership position u2022 Min. 2 years experience managing/supervising employees. PREFERRED EDUCATION : Masteru2019s Degree in Health or Business related field PREFERRED EXPERIENCE : u2022 5-7 years managed healthcare administration experience. u2022 Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals). 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. Pay Range: $80,168 - $149,028 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-01-08