Specialist, Health Plan Provider Engagement (Remote)

About the role

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.

Responsibilities

• Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
• Ensures assigned tier II and tier III providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
• Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness.
• Works collaboratively with health plan and shared service partners to ensure alignment to business goals.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies.
• Communicates effectively with internal and external stakeholders, including providers, practice managers, and medical assistants within assigned provider practices.
• Maintains the highest level of compliance.
• May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.

Requirements

• At least 2 years of experience improving provider quality performance through provider engagement, practice transformation, and/or managed care quality improvement initiatives, or equivalent combination of relevant education and experience.
• Experience with various managed health care provider compensation methodologies including but not limited to: fee-for service (FFS), value-based care (VBC), and capitation.
• Working knowledge of quality metrics and risk adjustment practices across all business lines.
• Knowledge and understanding of HEDIS/NCQA.
• Proficiency with data analysis, manipulation, interpretation and reporting.
• Critical-thinking, problem-solving and analytical skills.
• Relationship building skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Qualifications

• At least 2 years of experience improving provider quality performance through provider engagement, practice transformation, and/or managed care quality improvement initiatives, or equivalent combination of relevant education and experience.
• Experience with various managed health care provider compensation methodologies including but not limited to: fee-for service (FFS), value-based care (VBC), and capitation.
• Working knowledge of quality metrics and risk adjustment practices across all business lines.
• Knowledge and understanding of HEDIS/NCQA.
• Proficiency with data analysis, manipulation, interpretation and reporting.
• Critical-thinking, problem-solving and analytical skills.
• Relationship building skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Skills

• Experience improving quality performance for Medicaid, Medicare, and/or Marketplace programs.

Benefits

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay

Pay Range: $45,390 - $80,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Schedule

Full Time