Molina Healthcare

Senior Specialist, Health Plan Provider Engagement (Remote in NM)

Molina Healthcare • $75K — $95K *
Nu Mine, PA 16244In-Person
Healthcare
Less than 5 years of experience
1 week ago
Job Overview by Ladders

Qualifications

  • 3+ years achieving population-level HEDIS quality scores through provider engagement.
  • Knowledge of managed care provider compensation models (FFS, VBC, capitation).
  • Familiarity with quality metrics and risk adjustment methodologies.
  • Understanding HEDIS, NCQA, and CMS STARs measures for all health programs.
  • Data analysis and reporting proficiency, especially in Excel and Power BI.
  • Strong relationship-building and communication skills.
  • Ability to independently manage projects in fast-paced environments.

Responsibilities

  • Support provider engagement by enhancing risk adjustment and quality improvement strategies.
  • Ensure assigned providers develop and execute engagement plans for quality targets.
  • Facilitate coaching to improve quality performance and risk adjustment accuracy.
  • Coordinate scheduling to ensure members receive necessary care for identified gaps.
  • Identify and resolve barriers affecting program goal achievement.
  • Drive participation in Molina's risk adjustment and quality initiatives.
  • Track engagement and training effectiveness using standardized tools.

Benefits

  • Comprehensive health benefits including medical, dental, and vision.
  • Retirement savings plan with company match.
  • Generous paid time off and holidays.
  • Opportunities for professional development and training.
  • Flexible work arrangements, including remote work options.
Full Job Description
Job Description

JOB SUMMARY:

Provides senior level 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. Ensures assigned Tier 1 & Tier 2 providers have engagement plans ensuring they meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives.

ESSENTIAL JOB DUTIES:
  • Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
  • Ensures assigned Tier 1, Tier 2, and where applicable 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 the Molina members with the most open gaps on the schedule and 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.
  • Provides training and support for new and existing practice transformation and provider engagement team members.
  • Maintains the highest level of compliance.
  • May require same day out-of-office travel up to 75% of the time, depending upon state/health plan requirements.


REQUIRED QUALIFICATIONS:
  • At least 3 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.

#PJHPO

#LI-AC1

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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Healthcare
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ
MOH
* Ladders Estimates

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