Carl Jackson

Provider Network Manager @Molina Healthcare

MI, US

Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Network functions with an emphasis on contracting, education, outreach and resolving provider inquiries.In conjunction with the Director, Provider Network Management & Operations, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.Targets and recruits additional providers to reduce member access grievances.Develops and deploys strategic network planning tools to drive Provider Services and Contracting Strategy across the enterprise.Facilitates strategic planning and documentation of network management standards and processes.Works collaboratively with functional business unit stakeholders to lead and/or support various provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization.Assesses contract language for compliance with corporate standards and regulatory requirements and review revised language with assigned MHI attorney.Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal.Educates internal customers on provider contracts.

Lawrence Technological University

Certified

Oakland University

Bachelor of Arts (B.A.)