Senior Provider Engagement & Quality Improvement Specialist

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

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a Senior Provider Engagement Specialist to drive value-based care through provider engagement plans and data-driven risk adjustment initiatives in New Mexico.

You will coach and collaborate with Tier 1–3 providers, coordinate with health plan teams, and track activities with standard tools, ensuring compliance with policies while supporting travel up to 80% as required by state and plan requirements.

Qualifications

• Experience with HEDIS/NCQA or CMS STARs quality measures across Medicaid, Medicare and Marketplace.
• Strong data analysis, interpretation and reporting skills.
• Ability to implement process improvements in a fast-paced environment.

Responsibilities

• Provide senior support for provider engagement and risk adjustment initiatives.
• Develop and ensure provider engagement plans to meet quality goals.
• Coach providers to improve Medicaid/Medicare/Marketplace performance and risk adjustment.
• Coordinate with provider front-office and health plan teams to address gaps.
• Track engagement and training activities using standard tools.
• Ensure compliance with policies and drive cross-functional collaboration.
• Travel up to 80% as required by state/plan requirements.

Skills

HEDIS quality

Data analysis

Communication skills

Problem solving

Relationship building

Attention to detail

Independence

Process improvement

Cross-functional collaboration

Education

Bachelor’s degree in Nursing

Health Administration

Tools

Power BI

Excel

Job description

Molina Healthcare is seeking a Senior Provider Engagement Specialist to drive value-based care through provider engagement plans and data-driven risk adjustment initiatives in New Mexico.

You will coach and collaborate with Tier 1–3 providers, coordinate with health plan teams, and track activities with standard tools, ensuring compliance with policies while supporting travel up to 80% as required by state and plan requirements.