Specialist, Health Plan Provider Engagement (Remote)
Hybrid · Beaumont, Texas, United States
Job Summary
Provides support for health plan provider engagement activities. Drives value-based care strategies through risk adjustment and quality improvement activities. Ensures smaller, less advanced tier II and tier III providers have engagement plans to 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 duties include developing, organizing, analyzing, documenting and implementing processes and procedures as prescribed by health plan and corporate policies; communicating effectively with internal and external stakeholders; maintaining compliance; and travel up to 80% depending upon state/health plan requirements.
Required 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.
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