[Hiring] Senior Specialist, Health Plan Provider Engagement @Molina Healthcare

Role Description

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.

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.

Requirements

• May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.

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.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.