Senior Provider Engagement & Quality Risk Strategist

Molina Talent Acquisition; Louisville (KY); Remote; USD 90,000 - 130,000; Full time

Job summary

Molina Healthcare seeks a senior provider engagement specialist to support engagement strategies and risk adjustment activities across Medicaid, Medicare and Marketplace programs. You will drive coaching and collaboration with physicians through actionable data and analytics to improve health outcomes.

The role emphasizes engagement planning for Tier 1–3 providers, with regular meetings and action plans to meet annual quality and risk goals while ensuring compliance and robust data tracking

Qualifications

• 3+ years improving population-level HEDIS quality scores through provider engagement.
• Experience with FFS, VBC and capitation in managed care.
• Knowledge of HEDIS/NCQA and CMS STARs across Medicaid, Medicare & Marketplace.
• Proficient data analysis, interpretation and reporting.
• Strong communication and relationship-building skills.
• Ability to work independently in a fast-paced environment.
• Proficiency with Excel and Power BI.

Responsibilities

• Supports provider engagement activities to enhance value-based strategies and risk adjustment.
• Ensures provider engagement plans meet annual quality and risk goals.
• Coaches and collaborates with providers to improve Medicaid, Medicare and Marketplace quality.
• Coordinates with provider staff to identify open gaps and drive scheduling improvements.
• Addresses environmental challenges to reach program goals and health outcomes.
• Promotes participation in risk adjustment and quality initiatives with data exchange tools.
• Tracks engagement and training activities using standard tools.
• Serves as a subject-matter expert on provider engagement across plans.

Skills

Analytical thinking

Relationship building

Attention to detail

Change management

Independent work

Cross-functional collaboration

Verbal communication

Written communication

Education

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

Tools

Power BI

Excel

Microsoft Office

Job description

Molina Healthcare seeks a senior provider engagement specialist to support engagement strategies and risk adjustment activities across Medicaid, Medicare and Marketplace programs. You will drive coaching and collaboration with physicians through actionable data and analytics to improve health outcomes.

The role emphasizes engagement planning for Tier 1–3 providers, with regular meetings and action plans to meet annual quality and risk goals while ensuring compliance and robust data tracking