Provider Engagement Lead – Health Plan Quality & Risk

Molina Healthcare; Rio Rancho (NM); Remote; USD 55,000 - 100,000; Full time

Job summary

Molina Healthcare is seeking a senior provider engagement specialist to support health plan provider engagement strategies and risk adjustment activities. You will work with physicians and front-office staff to ensure engagement plans meet annual quality and risk adjustment goals, and drive value-based care through data-driven coaching.

The role emphasizes collaboration across plan teams, training, and problem resolution for assigned providers, with up to 80% travel as required by state and plan

Qualifications

• Experience improving HEDIS quality scores through provider engagement.
• Knowledge of CMS STARs, HEDIS/NCQA across Medicaid/Medicare/Marketplace.
• Strong data manipulation, interpretation and reporting skills.

Responsibilities

• Provides support for provider engagement activities including enhancing value-based strategies.
• Drives coaching and collaboration to improve quality performance and risk adjustment accuracy.
• Tracks engagement and training activities using standard tools to measure effectiveness.

Skills

Provider engagement

Data analysis

Power BI

Excel

Relationship building

Project management

Communication

Education

Bachelor's degree

Tools

Power BI

Excel

Job description

Molina Healthcare is seeking a senior provider engagement specialist to support health plan provider engagement strategies and risk adjustment activities. You will work with physicians and front-office staff to ensure engagement plans meet annual quality and risk adjustment goals, and drive value-based care through data-driven coaching.

The role emphasizes collaboration across plan teams, training, and problem resolution for assigned providers, with up to 80% travel as required by state and plan