Senior Health Plan Provider Engagement & Quality Coach

Molina Healthcare; Kentucky; Remote; USD 85,000 - 110,000; Full time

Job summary

Molina Healthcare is seeking a senior-level professional to support provider engagement strategies aimed at improving quality and risk adjustment outcomes. The role emphasizes data-driven coaching, collaboration with providers, and cross-functional coordination to meet annual goals across Medicaid, Medicare, and Marketplace plans.

The position involves working with office staff to address scheduling gaps, driving improvement plans, and ensuring compliant, effective provider engagement activities

Qualifications

• 3+ years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement.

Responsibilities

• Provides senior level support for implementation of provider engagement strategies and activities to drive quality and risk adjustment outcomes.
• Drives coaching and collaboration with providers to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy.
• Works with provider front-office staff to engage Molina members with open gaps and ensure they are seen by their providers.
• Establishes and tracks provider engagement plans to meet annual quality and risk adjustment goals.
• Maintains compliance and coordinates with Health Plan Community and Member Engagement resources as needed.

Skills

Data analysis

Problem-solving

Relationship building

Attention to detail

Communication

Independent work

Time management

Education

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

Tools

Microsoft Office

Excel

Power BI

Job description

Molina Healthcare is seeking a senior-level professional to support provider engagement strategies aimed at improving quality and risk adjustment outcomes. The role emphasizes data-driven coaching, collaboration with providers, and cross-functional coordination to meet annual goals across Medicaid, Medicare, and Marketplace plans.

The position involves working with office staff to address scheduling gaps, driving improvement plans, and ensuring compliant, effective provider engagement activities