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Provider Network Remote Jobs in California (NOW HIRING)

Oscar Health

Product Manager, Network

San Francisco, CA · Remote

$135K - $178K/yr

... our provider network nationwide. You will collaborate with business and tech teams to build ... This is a remote position, open to candidates who reside in: San Francisco, CA. You will be fully ...

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Provider Network Remote information

What is the difference between Provider Network Remote vs Provider Relations Specialist?

AspectProvider Network RemoteProvider Relations Specialist
CredentialsTypically requires healthcare or insurance certificationsSimilar certifications, often including healthcare administration
Work EnvironmentRemote, independent work with healthcare providersOffice or remote, focusing on communication with providers
Industry UsageUsed in health insurance and managed care organizationsCommon in insurance companies and healthcare networks
Search & Comparison IntentUnderstanding remote provider network rolesLearning about provider relations and communication roles

Provider Network Remote and Provider Relations Specialist roles share similar credentials and industry settings, but differ mainly in focus. Provider Network Remote emphasizes managing provider networks remotely, while Provider Relations Specialists focus on building relationships and communication with providers, often in an office setting.

What are the most commonly searched types of Provider Network jobs in California? The most popular types of Provider Network jobs in California are:
What are popular job titles related to Provider Network Remote jobs in California? For Provider Network Remote jobs in California, the most frequently searched job titles are:
What job categories do people searching Provider Network Remote jobs in California look for? The top searched job categories for Provider Network Remote jobs in California are:
What cities in California are hiring for Provider Network Remote jobs? Cities in California with the most Provider Network Remote job openings:
Provider Network Remote jobs near you
Business Analyst, Provider Network (Salesforce Needed) Remote

Business Analyst, Provider Network (Salesforce Needed) Remote

Molina Healthcare

Long Beach, CA • Remote

Full-time

Posted 11 days ago

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

134th of 281 rated insurance

Job description

Molina Healthcare is hiring for a Business Analyst, Provider Network.  

Highly qualified candidates will have the following experience:

  • Salesforce knowledge, a certification is helpful
  • Managed Care / Healthcare experience in the Provider space. 
  • Business Operations experience. 

Job Summary

Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. 

JOB DUTIES

  • Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements.
  • Monitors sources to ensure all updates are aligned. 
  • Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.
  • Conducts analysis to identify root cause and assist with problem management as it relates to state requirements.
  • Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.
  • Provides support for requirement interpretation inconsistencies and complaints.
  • Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.
  • Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.

KNOWLEDGE/SKILLS/ABILITIES

  • Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning.
  • Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
  • Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.
  • Ability to concisely synthesize large and complex requirements.
  • Ability to organize and maintain regulatory data including real-time policy changes.
  • Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.
  • Ability to work independently in a remote environment.
  • Ability to work with those in other time zones than your own.

JOB QUALIFICATIONS

Required Qualifications

  • At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.  
  • Policy/government legislative review knowledge.
  • Strong analytical and problem-solving skills.
  • Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
  • Previous success in a dynamic and autonomous work environment.

Preferred Qualifications

  • Project implementation experience 
  • Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). 
  • Medical Coding certification. 

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.

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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