Provider Engagement Specialist: Risk Adjustment & Quality

Molina Healthcare; Jackson (MS); Remote; USD 40,851 - 70,000; Full time

Job summary

Molina Healthcare seeks a Provider Engagement Specialist to support value-based care through risk adjustment and quality improvement activities. The role focuses on Tier 2 and Tier 3 providers, driving engagement plans and regular coaching to close care gaps.

Responsibilities include coordinating with frontline staff, tracking activities, and ensuring compliance with Molina’s engagement framework across Medicaid, Medicare and Marketplace programs.

Qualifications

• Minimum 2 years of experience improving population-level HEDIS quality scores and documentation accuracy through provider engagement.
• Knowledge of HEDIS/NCQA and CMS STARs measures across Medicaid, Medicare and Marketplace.
• Proficiency with data analysis, interpretation and reporting.

Responsibilities

• Provides support for provider engagement activities including enhancing value-based strategies and risk adjustment/quality initiatives.
• Ensures Tier 2 and Tier 3 providers have a engagement plan to meet annual performance goals.
• Drives coaching and collaboration to improve quality and risk adjustment accuracy through regular meetings and action items.
• Coordinates with front-office staff to identify open gaps and align with health plan resources to improve member outcomes.
• Maintains compliance and uses standard provider engagement tools to measure effectiveness.

Skills

Provider engagement

Data analysis

HEDIS quality improvement

Critical thinking

Relationship building

Communication skills

Problem solving

Attention to detail

Process improvement

Independent work

Education

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

Tools

Power BI

Excel

Microsoft Office

EMR systems

Job description

Molina Healthcare seeks a Provider Engagement Specialist to support value-based care through risk adjustment and quality improvement activities. The role focuses on Tier 2 and Tier 3 providers, driving engagement plans and regular coaching to close care gaps.

Responsibilities include coordinating with frontline staff, tracking activities, and ensuring compliance with Molina’s engagement framework across Medicaid, Medicare and Marketplace programs.