Senior Health Plan Provider Engagement Lead

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

Job summary

Molina Healthcare is seeking a senior Provider Engagement Specialist in Albuquerque, NM to drive value-based care through risk adjustment and quality improvement initiatives. You will engage Tier 1-3 providers with actionable data, coaching, and regular action plans to meet annual goals.

Responsibilities include coordinating with provider front-office staff, tracking activities with standard tools, and ensuring compliance while collaborating with Health Plan Community and Member Engagement

Qualifications

• At least 3 years of experience improving population-level HEDIS quality scores and documentation accuracy through provider engagement.
• Experience with value-based care, risk adjustment and quality improvement initiatives.
• Knowledge of HEDIS/NCQA and CMS STARs measures across Medicaid, Medicare and Marketplace.
• Proficiency in data analysis, interpretation, and reporting.
• Strong communication, problem-solving and relationship-building skills.

Responsibilities

• Provides support for provider engagement activities including value-based strategies and risk adjustment/quality improvement.
• Ensures provider engagement plans meet annual quality and risk adjustment goals.
• Drives coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance.
• Coordinates with provider front-office staff to schedule patients with high gaps for assigned providers.
• Tracks engagement and training activities using standard tools to measure effectiveness.
• Serves as subject matter expert and collaborates with health plan and shared service partners.
• Maintains compliance and supports training for provider engagement team members.
• May require travel up to 80% depending on state/health plan requirements.

Skills

Provider engagement

Data analysis

Power BI

Excel

Quality metrics

Cross-functional collaboration

Education

Bachelor’s degree in Nursing/Health Administration

Tools

Excel

Power BI

Pivot tables

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Job description

Molina Healthcare is seeking a senior Provider Engagement Specialist in Albuquerque, NM to drive value-based care through risk adjustment and quality improvement initiatives. You will engage Tier 1-3 providers with actionable data, coaching, and regular action plans to meet annual goals.

Responsibilities include coordinating with provider front-office staff, tracking activities with standard tools, and ensuring compliance while collaborating with Health Plan Community and Member Engagement