Top 243 Senior representative Jobs in Perris, Ca

Senior Representative, Health Plan Provider Relations (Must Reside in CA)
Molina Healthcare, Inc. —Menifee, CA
- $73,008 - $111,967 a year
- Full-time
- Medical office experience
- Contracts
- Senior level
- Health insurance
14d
Manager, Replenishment
Skechers USA, Inc. —Rancho Belago, CA
- $120,000 - $124,000 a year
- Full-time
- 5 years
- Bachelor's degree
- Senior level
Quick Apply
Autism Behavior Interventionist
The Carolyn E. Wylie Center —Riverside, CA
- $20 - $22 an hour
- Part-time
- Bilingual
- Background check
- Basic math
- Professional development assistance
- Referral program
Quick Apply
Clinical Biomarker & Diagnostics Quality
Magnit Global —California
- $55 - $62 an hour
- Contract
- Remote
- Background check
- Senior level
- Health insurance
- Dental insurance
Quick Apply
1h
Senior Maintenance Mechanic (Mechanical / Electrical)
Teledyne Battery Products —Redlands, CA
- From $43 an hour
- Full-time
- Background check
- Computer literacy
- English
- Health savings account
- Health insurance
Quick Apply
Salesperson
Riverside Fence Co Inc —Riverside, CA
- $70,000 - $200,000 a year
- Full-time
- Hybrid work
- Bilingual
- Clean driving record
- Construction site
- Fuel card
Quick Apply
1d
Senior Project Manager – Restoration & Reconstruction (Residential & Commercial)
JCS Restoration —Lake Elsinore, CA
- $80,000 - $90,000 a year
- Full-time
- Construction site
- 5 years
- Residential
- Health insurance
- Dental insurance
Quick Apply
Healthcare Enrollment Sales Representative – Senior Healthcare
Innova People —San Bernardino, CA
- Up to $69,000 a year
- Full-time
- Mid-level
- Driver's License
- Travel
- Mileage reimbursement
- Health savings account
Quick Apply
8d
Healthcare Sales Representative
Pursuit Sales Solutions —San Bernardino, CA
- $105,000 - $130,000 a year
- Full-time
- Spanish
- Sales
- English
- Travel reimbursement
- Mileage reimbursement
Quick Apply
9d
Financial Professional with Management Opportunity
New York Life Insurance Company —Riverside, CA
- $51,000.00 - $156,603.44 a year
- Full-time
- Mid-level
- Business development
- US work authorization
- AD&D insurance
- Disability insurance
Quick Apply
8d
Senior Logistics Manager
Accurate Personnel —Redlands, CA
- $85,000 - $95,000 a year
- Weekends as needed
- Microsoft Outlook
- Customer service
- 5 years
Quick Apply
Employee & Labor Relations Manager
Yuhaaviatam of San Manuel Nation —Highland, CA
- Extended hours
- Background check
- Hospitality
- Office
- Health insurance
- Dental insurance
Quick Apply
HR Business Partner, Manager
Skechers USA, Inc. —Rancho Belago, CA
- Full-time
- Bachelor's degree
- Continuous improvement
- Organizational skills
Quick Apply
Senior Representative, Guest Services
Yaamava Resort & Casino at San Manuel —Highland, CA
- Extended hours
- Microsoft Excel
- High school diploma or GED
- Travel
Customer Service Representative
Matthews International Corporation —Fontana, CA
- Overtime
- Microsoft Outlook
- Basic math
- Mid-level
Senior P&O Business Partner/HR Business Partner
DSV —Riverside, CA
- $82,000 - $90,000 a year
- Customer service
- Computer literacy
- Research
Senior HR Representative
Yuhaaviatam of San Manuel Nation —Highland, CA
- Extended hours
- Spanish
- Mid-level
- Office
Office Assistant
San Bernardino County Transportation Authority —San Bernardino, CA
- $20.33 - $30.50 an hour
- 8 hour shift
- Word processing
- Writing skills
- Basic math
- Wellness program
- Paid jury duty
3d
Sr. Leave of Absence Specialist
University of California, Riverside —Riverside, CA
- $68,500 - $121,900 a year
- Full-time
- Background check
- HIPAA
- Windows
Senior Manager, Operations Training
Simpson Strong-Tie Company Inc. —Riverside, CA
- $123,700 - $210,300 a year
- Full-time
- Pass drug screening
- Office
- 8 years
- Paid jury duty
- Health insurance
Quick Apply

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Senior Representative, Health Plan Provider Relations (Must Reside in CA)

Molina Healthcare, Inc. -
Menifee, CA

Apply Now

Job Details

Full-time
$73,008 - $111,967 a year
14 days ago

Benefits

Health insurance

Qualifications

Customer training
Medicare
Managed care organization experience
Medical office experience
Educational talks
Schedule management
Corporate training teaching experience
Health insurance knowledge
Medicare regulations
Desktop applications
Medicaid regulations
Medicaid
Productivity software
Cross-functional collaboration
Cross-functional communication
Staff development

Full Job Description

JOB DESCRIPTION Job Summary

Provides senior level 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 the plan's highest priority, high-volume and strategic complex community 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 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.
Resolves complex provider issues that may cross departmental lines and involve senior leadership.
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.).
Serves as a subject matter expert for the provider relations function.
Provides training and support to new and existing provider relations team members.
Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).

Required Qualifications

At least 3 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.
Understanding of the health care delivery system, including government-sponsored health plans.
Understanding of 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.
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

Experience in provider services, operations, and/or contract negotiations in a Medicaid, Medicare, and/or Marketplace managed health care setting - ideally with different provider types (i.e. physician, group, hospital).

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

Apply Now

Refine Your Search

senior representative jobs in perris, ca

Senior Representative, Health Plan Provider Relations (Must Reside in CA)

Manager, Replenishment

Autism Behavior Interventionist

Clinical Biomarker & Diagnostics Quality

Senior Maintenance Mechanic (Mechanical / Electrical)

Salesperson

Senior Project Manager – Restoration & Reconstruction (Residential & Commercial)

Healthcare Enrollment Sales Representative – Senior Healthcare

Healthcare Sales Representative

Financial Professional with Management Opportunity

Senior Logistics Manager

Employee & Labor Relations Manager

HR Business Partner, Manager

Senior Representative, Guest Services

Customer Service Representative

Senior P&O Business Partner/HR Business Partner

Senior HR Representative

Office Assistant

Sr. Leave of Absence Specialist

Senior Manager, Operations Training

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