Provider Engagement & Quality/Risk Adjustment Specialist

Molina Healthcare; Long Beach (CA); Remote; USD 52,000 - 102,000; Full time

Job summary

Molina Healthcare is hiring for a Provider Engagement Specialist to support the implementation of health plan provider engagement strategies and risk adjustment initiatives. The role emphasizes physician engagement, data-driven coaching, and collaboration to improve Medicaid, Medicare, and Marketplace quality performance.

You will drive engagement plans, coach providers, and coordinate with health plan teams to overcome practice environment challenges, ensuring timely action and improved health

Qualifications

• Experience improving population-level HEDIS quality scores through provider engagement.
• Knowledge of HEDIS/NCQA and CMS STARs quality measures across Medicaid, Medicare and Marketplace.
• Experience with data analysis, manipulation, interpretation, and reporting.

Responsibilities

• Support provider engagement activities including value-based strategies and risk adjustment initiatives.
• Ensure Tier 2/3 providers have engagement plans to meet annual goals.
• Coach providers to improve quality and risk adjustment performance through meetings and action items.
• Coordinate with front-office staff to identify Molina members with open gaps and schedule views.
• Address practice environment challenges to meet program goals and improve outcomes.
• Encourage participation in risk adjustment and quality efforts via data sharing and portal use.
• Track engagement and training activities using standard Molina tools to measure effectiveness.

Skills

Data analysis

Provider engagement

HEDIS quality scores

Communication

Problem solving

Attention to detail

Power BI

Education

Bachelor’s degree in Nursing, Health Administration or relevant discipline

Tools

Microsoft Excel

Power BI

EMR systems

Healthcare analytics software

Job description

Molina Healthcare is hiring for a Provider Engagement Specialist to support the implementation of health plan provider engagement strategies and risk adjustment initiatives. The role emphasizes physician engagement, data-driven coaching, and collaboration to improve Medicaid, Medicare, and Marketplace quality performance.

You will drive engagement plans, coach providers, and coordinate with health plan teams to overcome practice environment challenges, ensuring timely action and improved health