Senior Provider Engagement Strategist

Molina Healthcare; New Mexico; A distancia; USD 85.000 - 115.000; Jornada completa

Descripción de la vacante

Molina Healthcare in the United States seeks a Senior Provider Engagement Specialist to drive value-based care through risk adjustment and quality improvement initiatives. You will coach providers, coordinate with front-office teams, and track progress using standard engagement tools.

Responsibilities include developing engagement plans for Tier 1–3 providers, collaborating cross-functionally, and ensuring compliance across Medicaid, Medicare, and Marketplace programs.

Formación

• 3+ years improving HEDIS quality scores through provider engagement.
• Experience with FFS, VBC and capitation reimbursement models.
• Knowledge of HEDIS/NCQA and CMS STARs measures and risk adjustment.
• Proficiency in data analysis, interpretation and reporting.
• Strong verbal and written communication and collaboration skills.
• Ability to work independently in a fast-paced, deadline-driven environment.

Responsabilidades

• Provide support for provider engagement activities, improving value-based strategies and quality/risk initiatives.
• Ensure provider engagement plans meet annual quality and risk adjustment goals.
• Drive coaching and collaboration to improve Medicaid, Medicare, and Marketplace performance.
• Coordinate with front-office staff to schedule members with open gaps for assigned providers.
• Address barriers in the practice environment to achieve program goals.
• Promote provider participation in risk adjustment and quality initiatives.
• Track engagement and training activities using standard tools; support data exchanges.
• Serve as provider engagement subject matter expert and collaborate with partners.
• Work with Health Plan Relations Network members on operational issues.
• Develop, document and implement processes per policies; ensure compliance.
• Communicate with physician leaders, providers and staff; provide training as needed.
• Maintain high level of compliance; travel up to 80% may be required.

Conocimientos

Provider engagement

Data analysis

Communication skills

Problem solving

Attention to detail

Independent work

Cross-functional collaboration

Educación

Bachelor’s degree in Nursing

Bachelor’s degree in Health Administration

Herramientas

Excel

Power BI

Descripción del empleo

Molina Healthcare in the United States seeks a Senior Provider Engagement Specialist to drive value-based care through risk adjustment and quality improvement initiatives. You will coach providers, coordinate with front-office teams, and track progress using standard engagement tools.

Responsibilities include developing engagement plans for Tier 1–3 providers, collaborating cross-functionally, and ensuring compliance across Medicaid, Medicare, and Marketplace programs.