Top 41664 Clinical Services Representative Jobs

Representative, Health Plan Provider Relations - Remote Must reside in NY
Molina Healthcare —New York, NY
- $19.84 - $46.42 an hour
- Full-time
- Remote
- Medical office experience
- Mid-level
- Travel
- Health insurance
Nurse Manager | Medical Oncology & Medical Specialties
Concord Hospital —Concord, NH
- Full-time
- Acute care
- Nursing
- RN License
- Disability insurance
- Health insurance
Administrative Registered Nurse
Divine House, Inc. —Willmar, MN
- $38 - $40 an hour
- Full-time
- CPR Certification
- Nursing
- Clean driving record
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse - East Aurora area
SUBURBAN ADULT SERVICES INC. —Elma, NY
- $76,960 a year
- 18 years or older
- Nursing
- Current TB test
Quick Apply
Inpatient/ Primary Care Physician
Kedren Community Health Center Inc —Los Angeles, CA
- $185,000 a year
- On call
- CPR Certification
- Medicine
- BLS Certification
Quick Apply
Children's Residential Center Therapist
Christian Children's Home of Ohio —Wooster, OH
- Full-time
- Writing skills
- LPC
- Mid-level
Quick Apply
Clinical Nurse Manager - Maternal Newborn - Children's Hospital
University of Missouri Health Care —Columbia, MO
- $108,971 - $177,590 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Paid holidays
- Health insurance
Physician - Allergist/Immunologist
Family Allergy & Asthma —Avon, IN
- Full-time
- Clinic
- Travel
- Senior level
Quick Apply
Occupational Therapist (OT)-Home Health-Salinas
Silverline Staff Inc —Salinas, CA
- From $150 an hour
- Part-time
- CPR Certification
- BLS Certification
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
12d
Supervisor, Respiratory Care - Nights
University of Missouri Health Care —Columbia, MO
- $78,520.00 - $127,961.60 a year
- 12 hour shift
- Acute care
- Inpatient
- Mid-level
- Paid holidays
- Loan repayment program
Registered Nurse (RN) | Women's Center
Avera Health —Mitchell, SD
- $32.50 - $48.50 an hour
- Part-time
- Nursing
- OSHA
- RN License
- Loan repayment program
- Paid time off
Quick Apply
LPCC (Licensed Professional Clinical Counselor)
New Life Treatment Center —Woodstock, MN
- $75,000 - $95,000 a year
- Full-time
- Background check
- LMFT
- Computer literacy
- Health insurance
- Paid time off
Quick Apply
Regional Medical Director
TapestryHealth —Orlando, FL
- $200,000 - $250,000 a year
- Full-time
- Medicine
- Management
- 3 years
Quick Apply
Lead Clinical Supervisor - Night Shift, CDF
DESC —Seattle, WA
- $97,701.60 - $110,540.40 a year
- Full-time
- LMFT
- Spanish
- Addiction Medicine
- Disability insurance
- Health insurance
Quick Apply
Registered Nurse (RN) – Adult Medical Care – Days or Nights
University of Missouri Health Care —Columbia, MO
- $34.46 - $51.02 an hour
- 12 hour shift
- Nursing
- RN License
- Inpatient
- Paid holidays
- Loan repayment program
Nurse Practitioner - F/T - Reno, NV
MEDEVAL —Reno, NV
- $120,000 - $150,000 a year
- Extended hours
- Nursing
- Blood sampling
- Microsoft Excel
Quick Apply
Physician - Family Practice
Gracelight Community Health —Los Angeles, CA
- $212,049 - $339,241 a year
- Full-time
- Spanish
- CPR Certification
- Medicine
Quick Apply
Physical Therapist
Matrix Providers —Bremerton, WA
- $57 - $60 an hour
- Full-time
- Physical & Rehabilitation Medicine
- Mid-level
- In-person
- Paid holidays
- Health insurance
Quick Apply
Certified Registered Nurse Anesthetist (CRNA)
Copley Hospital —Morrisville, VT
- $130 - $135 an hour
- Part-time
- Nursing
- PALS Certification
- BLS Certification
Pharmacist-in-Charge
VytlOne —Anniston, AL
- Online Application
- Mid-level
- Outpatient experience
- Data entry
- Health savings account
- AD&D insurance
Quick Apply

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Representative, Health Plan Provider Relations - Remote Must reside in NY

Molina Healthcare -
New York, NY

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Job Details

Full-time
$19.84 - $46.42 an hour

Benefits

Health insurance

Qualifications

Customer communication
Managed care
Managed care organization experience
Medical office experience
Schedule management
Health insurance knowledge
Productivity software
Cross-functional collaboration
Cross-functional communication

Full Job Description

JOB DESCRIPTION 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.

will require to travel at least once a week subject to change.

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.

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 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

Clinical Services Representative jobs

Representative, Health Plan Provider Relations - Remote Must reside in NY

Nurse Manager | Medical Oncology & Medical Specialties

Administrative Registered Nurse

Registered Nurse - East Aurora area

Inpatient/ Primary Care Physician

Children's Residential Center Therapist

Clinical Nurse Manager - Maternal Newborn - Children's Hospital

Physician - Allergist/Immunologist

Occupational Therapist (OT)-Home Health-Salinas

Supervisor, Respiratory Care - Nights

Registered Nurse (RN) | Women's Center

LPCC (Licensed Professional Clinical Counselor)

Regional Medical Director

Lead Clinical Supervisor - Night Shift, CDF

Registered Nurse (RN) – Adult Medical Care – Days or Nights

Nurse Practitioner - F/T - Reno, NV

Physician - Family Practice

Physical Therapist

Certified Registered Nurse Anesthetist (CRNA)

Pharmacist-in-Charge

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