Specialist, Health Plan Provider Engagement (Remote in MI)
RemoteMichigan, United States
Job Summary
Drive provider engagement activities for Tier 2 and Tier 3 providers to meet annual quality and risk adjustment performance goals. Enhance value-based strategies and coordinate with Health Plan Community resources to address practice environment challenges and improve Medicaid, Medicare, and Marketplace quality outcomes. Conduct regular meetings, develop action plans, and track engagement using standard Molina tools to measure effectiveness across risk adjustment and quality initiatives. Serve as a subject matter expert collaborating with provider relations networks and implementing processes aligned with corporate policies. Maintain full compliance and communicate effectively with physician leaders and practice staff. Note that same-day out-of-office travel is required up to 80% of the time.
Required Qualifications
- At least 2 years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement
- 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
- Must be able to travel up to 80% of the time
Desired 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
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