Top 13861 Community representative Jobs in Texas

Representative, Health Plan Provider Relations (Remote)
Molina Healthcare —Texas
- $19.84 - $38.69 an hour
- Full-time
- Remote
- Medical office experience
- Mid-level
- EMR systems
- Health insurance
Customer Service Representative
UnitedHealthcare —Fort Worth, TX
- $16 - $29 an hour
- 8 hour shift
- Remote
- 18 years or older
- Spanish
- Computer literacy
- On-the-job training
1d
Representative I Client Support
CVS Health —Texas
- $17.00 - $28.46 an hour
- Full-time
- Remote
- High school diploma or GED
- Fair chance
- 1 year
- Health insurance
- Dental insurance
11h
Pharmacy Care Representative - Work From Home Texas (MST or CST)
CVS Health —Texas
- $17.00 - $28.46 an hour
- Overtime
- Remote
- Microsoft Excel
- Microsoft Outlook
- Windows
- Paid holidays
- Health insurance
Representative, Customer Experience Escalation and Resolution
American Airlines —Fort Worth, TX
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
5d
Broker Agent Service Representative
UnitedHealthcare —Fort Worth, TX
- $18 - $32 an hour
- Full-time
- Remote
- Bilingual
- Microsoft Excel
- Microsoft Outlook
Inbound Sales Representative (Remote/Central Time)
A Place for Mom —Texas
- $45,760 a year
- Weekends as needed
- Remote
- Microsoft Word
- Mid-level
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
Customer Service Representative (Remote)
Concentrix —Texas
- $15 an hour
- Urgently hiring
- Remote
- Microsoft Outlook
- Residential
- High school diploma or GED
- Paid training
- Paid holidays
Regional Business Controller
Crane Cartage LLC —Houston, TX
- 7 years
- Office
- Finance
- Wellness program
- Health insurance
14d
Director of Development Permian Basin Area
Ronald McDonald House Charities of the Southwest —Odessa, TX
- $63,000 - $68,000 a year
- Full-time
- Hybrid work
- Bilingual
- Background check
- Microsoft Excel
- 403(b) matching
- Health insurance
Quick Apply
Advertising Sales Representative
Times Media Group —San Marcos, TX
- Full-time
- Mid-level
- Business development
- In-person
- Paid holidays
- Health insurance
Quick Apply
14d
FT Home Health Physical Therapist (30K SIGN ON)
Advanced Home Health Services —Conroe, TX
- Full-time
- CPR Certification
- Current TB test
- BLS Certification
- Mileage reimbursement
- Health savings account
Quick Apply
9h
Principal Automation Systems Engineer, NA
Vantage Data Centers Management Company LLC —San Antonio, TX
- $155,000 - $165,000 a year
- Full-time
- Hybrid work
- Ability to climb stairs
- Quality control
- Travel
- AD&D insurance
- Disability insurance
Quick Apply
Licensed Professional Engineer, Electrical System Operations
UT Southwestern —Dallas, TX
- Full-time
- Management
- Construction site
- 5 years
- Paid parental leave
- Paid holidays
Outside Sales Representative
Connoisseur Media —Amarillo, TX
- From $30,000 a year
- Full-time
- Background check
- Mid-level
- Contracts
- Paid training
- Professional development assistance
Quick Apply
PRN Occupational Therapist, Acute - Katy
Memorial Hermann Health System —Katy, TX
- 8 hour shift
- Acute care
- Hospital
- Writing skills
Residential Sales Consultant
J19 Investments —McAllen, TX
- $60,000 - $150,000 a year
- Weekends as needed
- Marketing
- High school diploma or GED
- Driver's License
Quick Apply
Golf Cart Sales Representative
Lone Star Golf Cars —Midland, TX
- $50,000 - $100,000 a year
- Weekends as needed
- Background check
- Dealership
- Inventory management
- Paid training
- Health insurance
Quick Apply
Operations Manager - Entertainment Venue
CC Turnkey - 5th & Elm —Portland, TX
- $55,000 - $65,000 a year
- Extended hours
- Ability to walk for extended periods
- Mid-level
- Office
- Health insurance
- Dental insurance
Quick Apply
14d
Regional Compliance Manager
Zollege —Austin, TX
- $65,000 - $85,000 a year
- Full-time
- Hybrid work
- Google Workspace
- 5 years
- Writing skills
- Travel reimbursement
Quick Apply
7d

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Representative, Health Plan Provider Relations (Remote)

Molina Healthcare -
Texas

Apply Now

Job Details

Full-time
$19.84 - $38.69 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 SummaryProvides 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 60%+ 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 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 - $34 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

community representative jobs in texas

Representative, Health Plan Provider Relations (Remote)

Customer Service Representative

Representative I Client Support

Pharmacy Care Representative - Work From Home Texas (MST or CST)

Representative, Customer Experience Escalation and Resolution

Broker Agent Service Representative

Inbound Sales Representative (Remote/Central Time)

Customer Service Representative (Remote)

Regional Business Controller

Director of Development Permian Basin Area

Advertising Sales Representative

FT Home Health Physical Therapist (30K SIGN ON)

Principal Automation Systems Engineer, NA

Licensed Professional Engineer, Electrical System Operations

Outside Sales Representative

PRN Occupational Therapist, Acute - Katy

Residential Sales Consultant

Golf Cart Sales Representative

Operations Manager - Entertainment Venue

Regional Compliance Manager

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