Specialist, Health Plan Provider Engagement (Remote in MS)

Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and analytics. Drives value-based care strategies through risk adjustment and quality improvement activities. Focuses on smaller, less advanced Tier 2 and Tier 3 providers, ensuring they have engagement plans to meet annual quality and risk adjustment goals.

Responsibilities

• Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
• Ensures assigned Tier 2 and Tier 3 providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve Medicaid, Medicare, and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development, and execution.
• Works with provider front-office staff to get Molina members with the most open gaps on the schedule seen by their assigned provider.
• Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side.
• 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 both within and across Molina health plans.
• Serves as provider engagement subject matter expert; works collaboratively with health plan and shared service partners to ensure alignment to business goals.
• Collaborates with assigned health plan Provider Relations Network team member on operational, provider, and member issues.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Develops, organizes, analyzes, documents, and implements processes and procedures as prescribed by health plan and corporate policies.
• Communicates comfortably and effectively with internal and external stakeholders, including physician leaders, 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 population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement, 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 and/or CMS STARs quality measures and risk adjustment practices across Medicaid, Medicare, and Marketplace.
• 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 foster and build relationships in a cross-functional highly matrixed organization to obtain buy-in and drive results.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), Power BI, and other applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Bachelor’s degree in Nursing, Health Administration, or relevant discipline.
• Solid understanding of health insurance, provider messaging/design, and project management.
• Strong experience using Microsoft products, including Excel (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint.

Pay

Pay Range: $40,851.44 - $70,000 / ANNUAL. Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.