Sr. Specialist, Quality Provider Engagement (Remote/Day Travel/RN Preferred)

Lensa; Jackson (MS); Remote; USD 49,000 - 108,000; Full time

Job summary

An innovative healthcare organization is seeking a Sr. Specialist in Quality Provider Engagement to enhance provider performance and ensure compliance with quality metrics. This role involves developing engagement plans for Tier 2 and Tier 3 providers, driving collaboration, and addressing challenges in practice environments. The ideal candidate will have a strong background in healthcare quality improvement and data analytics, with excellent communication and leadership skills. Join a forward-thinking team dedicated to improving health outcomes through effective provider engagement strategies.

Qualifications

• 3+ years in provider engagement and quality performance improvement.
• Strong knowledge of managed care quality improvement methodologies.

Responsibilities

• Implement provider engagement strategies to achieve quality outcomes.
• Drive coaching and collaboration with providers to improve performance.

Skills

Provider Engagement

Quality Improvement

Data Analytics

Communication Skills

Leadership Skills

Education

Bachelor's degree in Business, Healthcare, Nursing

Tools

PowerPoint

Excel

Visio

Job description

Sr. Specialist, Quality Provider Engagement (Remote/Day Travel/RN Preferred)

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Remote and must live in Mississippi

Job Description

Job Summary

The Sr. Specialist, Provider Engagement role implements the Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the core set of Tier 2 providers in the Health Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies.

Job Duties

• Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development, and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g., Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal.
• Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans.
• Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
• Assists Provider Engagement Specialists with training and problem escalation.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education, and patient engagement activities.
• Develops, organizes, analyzes, documents, and implements processes and procedures as prescribed by Plan and Corporate policies.
• Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices.
• Maintains the highest level of compliance.
• This position may require same-day out-of-office travel approximately 0-80% of the time, depending on location.

Job Qualifications

REQUIRED QUALIFICATIONS:

• Bachelor's degree in Business, Healthcare, Nursing, or related field, or equivalent combination of education and relevant experience.
• Minimum 3 years experience improving provider quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Experience with various managed healthcare provider compensation methodologies including fee-for-service, value-based care, and capitation.
• Strong working knowledge of Quality metrics and risk adjustment practices across all business lines.
• Demonstrates data analytic skills.
• Operational knowledge and experience with PowerPoint, Excel, Visio.
• Effective communication skills.
• Strong leadership skills.

Preferred Qualifications

Minimum 3 years experience improving Quality performance for Medicaid, Medicare, and/or ACA Marketplace programs.

To all current Molina employees: If interested, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJNurse

Pay Range: $49,430.25 - $107,098.87 / ANNUAL

• Actual compensation may vary based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Quality Assurance
• Industries: IT Services and IT Consulting