Top 270 Senior representative Jobs in Redlands Ca

Senior Representative, Health Plan Provider Relations (Must Reside in CA)
Molina Healthcare, Inc. —Colton, CA
- $73,008 - $111,967 a year
- Full-time
- Medical office experience
- Contracts
- Senior level
- Health insurance
6d
Senior Representative, Guest Services
Yaamava Resort & Casino at San Manuel —Highland, CA
- Extended hours
- Microsoft Excel
- High school diploma or GED
- Travel
Senior HR Representative
Yuhaaviatam of San Manuel Nation —Highland, CA
- Extended hours
- Spanish
- Mid-level
- Office
Senior Administrative Services Analyst - Behavioral Health
County of Riverside —Riverside, CA
- $6,301.13 - $8,605.62 a month
- Monday to Friday
- Background check
- Mid-level
- Office
- Paid holidays
- Disability insurance
3d
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
Administrative Assistant II
San Bernardino Community College District —San Bernardino, CA
- $27.61 - $30.43 an hour
- Online Application
- School experience
- Current TB test
- Writing skills
6d
Construction Estimator
NATIONAL COMMUNITY RENAISSANCE —Rancho Cucamonga, CA
- $100,000 - $132,000 a year
- Full-time
- Construction site
- Bachelor of Science
- Data analysis skills
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
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
Senior Project Manager - Audio Visual Integration
Diversified —California
- $124,200 - $165,000 a year
- Full-time
- Hybrid work
- Construction site
- 5 years
- Writing skills
- Commuter assistance
- Paid parental leave
Quick Apply
Senior Logistics Manager
Accurate Personnel —Redlands, CA
- $85,000 - $95,000 a year
- Weekends as needed
- Microsoft Outlook
- Customer service
- 5 years
Quick Apply
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
15h
Community Relations Representative
Efficient California —Grand Terrace, CA
- $950 - $1,550 a week
- Full-time
- Mid-level
- Presentation skills
- In-person
- 401(k)
Quick Apply
2d
Compliance Analyst - Promotions & Procedures
Yaamava’ Resort & Casino at San Manuel —Highland, CA
- Extended hours
- Background check
- Clean driving record
- Research
- Health insurance
- Dental insurance
Quick Apply
13d
Employee & Labor Relations Manager
Yuhaaviatam of San Manuel Nation —Highland, CA
- Extended hours
- Background check
- Hospitality
- Office
- Health insurance
- Dental insurance
Quick Apply
Sr Surveillance Infrastructure Technician
Yuhaaviatam of San Manuel Nation —Highland, CA
- Extended hours
- Background check
- Clean driving record
- Construction site
- Health insurance
- Dental insurance
Quick Apply
8d
Senior Surveillance Agent
Yuhaaviatam of San Manuel Naton —Highland, CA
- Extended hours
- Background check
- Microsoft Excel
- Microsoft Outlook
Quick Apply
10d
Professional Expert - Program Assistant - Educational Opportunities Help Desk
San Bernardino Community College District —San Bernardino, CA
- $20 - $49 an hour
- Temporary
- Spanish
- Current TB test
- Data analysis skills
CA Utilization Review Nurse I
CorVel Corporation —Rancho Cucamonga, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- LVN
- RN License
- Health savings account
- Disability insurance
Quick Apply
Resident Assistant
HumanGood —Redlands, CA
- $18.06 - $21.65 an hour
- Part-time
- CPR Certification
- High school diploma or GED
- First Aid Certification
- Health savings account
- Health insurance
Quick Apply
13h

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

Molina Healthcare, Inc. -
Colton, CA

Apply Now

Job Details

Full-time
$73,008 - $111,967 a year
6 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 redlands ca

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

Senior Representative, Guest Services

Senior HR Representative

Senior Administrative Services Analyst - Behavioral Health

Manager, Replenishment

Administrative Assistant II

Construction Estimator

Autism Behavior Interventionist

Senior Maintenance Mechanic (Mechanical / Electrical)

Senior Project Manager - Audio Visual Integration

Senior Logistics Manager

Financial Professional with Management Opportunity

Community Relations Representative

Compliance Analyst - Promotions & Procedures

Employee & Labor Relations Manager

Sr Surveillance Infrastructure Technician

Senior Surveillance Agent

Professional Expert - Program Assistant - Educational Opportunities Help Desk

CA Utilization Review Nurse I

Resident Assistant

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