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Remote Provider Network Management Jobs in California

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Remote (Preference for candidates able to work East Coast or Central Time Zone hours) What You'll ... Partner closely with Network Management, Account Management, and Member Services teams to support ...

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Remote Provider Network Management information

What are the key skills and qualifications needed to thrive as a Remote Provider Network Management professional, and why are they important?

To thrive in Remote Provider Network Management, you need expertise in healthcare provider relations, contract negotiation, and a solid understanding of health plan regulations, often supported by a degree in healthcare administration or a related field. Familiarity with provider network management software, data analytics tools, and knowledge of regulations like HIPAA are typically required. Excellent communication, problem-solving abilities, and attention to detail are essential soft skills for building strong partnerships and managing network performance. These skills and qualifications ensure efficient network operations, regulatory compliance, and high-quality service for both providers and members.

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

AspectRemote Provider Network ManagementRemote Provider Relations Specialist
CredentialsHealthcare administration, network management certificationsCustomer service, healthcare communication certifications
Work EnvironmentHealthcare organizations, insurance companies, remote office settingsHealthcare providers, insurance companies, remote customer support
Industry UsageManaging provider networks, credentialing, contractingBuilding provider relationships, resolving provider issues

Remote Provider Network Management focuses on overseeing healthcare provider networks, including credentialing and contracting. In contrast, Remote Provider Relations Specialists primarily handle communication and relationship-building with providers. Both roles require healthcare knowledge but differ in their core responsibilities and focus areas.

How does a Remote Provider Network Management professional typically collaborate with healthcare providers and internal teams?

Remote Provider Network Management professionals frequently coordinate with healthcare providers via virtual meetings, emails, and secure online portals to address contract negotiations, credentialing, and performance issues. They also work closely with internal departments such as claims, quality assurance, and customer service to ensure seamless provider onboarding and ongoing support. Effective communication and strong relationship-building skills are essential, as much of the collaboration happens through digital channels. This setup allows for flexibility but requires self-motivation and proactive engagement to maintain strong provider networks.

What is a Remote Provider Network Management role?

A Remote Provider Network Management role involves overseeing relationships and contracts with healthcare providers, such as doctors, hospitals, and clinics, while working remotely. Professionals in this field are responsible for recruiting new providers, maintaining communication, ensuring compliance with regulations, and addressing network issues. They play a key part in expanding and maintaining a healthcare organization's provider network to ensure members have access to quality care. This job typically requires strong organizational, negotiation, and communication skills, as well as familiarity with healthcare regulations and provider credentialing processes.
What are the most commonly searched types of Provider Network Management jobs in California? The most popular types of Provider Network Management jobs in California are:
What are popular job titles related to Remote Provider Network Management jobs in California? For Remote Provider Network Management jobs in California, the most frequently searched job titles are:
What job categories do people searching Remote Provider Network Management jobs in California look for? The top searched job categories for Remote Provider Network Management jobs in California are:
What cities in California are hiring for Remote Provider Network Management jobs? Cities in California with the most Remote Provider Network Management job openings:
Remote Provider Network Management jobs near you
Specialist, Provider Network Administration

Specialist, Provider Network Administration

Molina Healthcare

Long Beach, CA • On-site, Remote

$18.94 - $36.93/hr

Full-time

Posted 5 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 196 frontline employees who took The Breakroom Quiz

160th of 298 rated insurance

Job description


JOB DESCRIPTION Job Summary
Provides support for provider network administration activities. Responsible for accurate and timely validation and maintenance of critical provider information on all claims and provider databases, and ensures adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
Essential Job Duties
• Receives information from outside parties for update of provider-related information in applicable computer system(s).
• Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided.
• Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment.
• Ensures accurate entries of information into health plan systems.
• Audits loaded provider records for quality and financial accuracy, and provides documented feedback.
• Assists in resolution of configuration issues with applicable teams.
• Provides support for provider network administration projects.
Required Qualifications
• At least 3 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, or equivalent combination of relevant education and experience.
• Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
• Attention to detail, and ability to facilitate accurate data entry/review.
• Data entry/processing skills.
• Customer service skills.
• Ability to manage multiple priorities and meet deadlines.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
• Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9, ICD-10) codes, etc.
• Intermediate Microsoft Excel skills.
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

What Molina Healthcare employees say

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About Molina Healthcare

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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

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