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

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

Job summary

A leading healthcare organization is seeking a Sr. Specialist in Provider Engagement to implement strategies that enhance quality and risk adjustment outcomes. This role involves coaching providers, tracking engagement activities, and ensuring compliance with policies. The ideal candidate will have a background in healthcare or business, with strong analytical and communication skills. This position offers the opportunity for significant impact in improving health outcomes through effective provider engagement.

Qualifications

• Minimum 3 years experience improving provider Quality performance.
• Experience with healthcare provider compensation methodologies.

Responsibilities

• Ensure assigned providers have a Provider Engagement plan.
• Drive provider partner coaching and collaboration.
• Track all engagement and training activities.

Skills

Data analytic skills

Effective communication skills

Strong leadership skills

Education

Bachelor’s degree in Business, Healthcare, Nursing, or related field

Tools

PowerPoint

Excel

Visio

Job description

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

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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

• Ensure assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals.
• Drive provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development, and execution.
• Address challenges/barriers in the practice environment impeding successful attainment of program goals and understand solutions required to improve health outcomes.
• Promote 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.
• Track all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness within and across Molina Health Plans.
• Serve as a Provider Engagement subject matter expert; collaborate within the Health Plan and with shared service partners to ensure alignment to business goals.
• Assist Provider Engagement Specialists with training and problem escalation.
• Use standard Molina Provider Engagement reports and training materials.
• Facilitate connectivity with internal partners to support data exchanges, documentation education, and patient engagement activities.
• Develop, organize, analyze, document, and implement processes and procedures as per Plan and Corporate policies.
• Communicate effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices.
• Maintain 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 experience
• Minimum 3 years experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or similar
• Experience with healthcare provider compensation methodologies (fee-for-service, value-based care, capitation)
• Strong knowledge of Quality metrics and risk adjustment practices across business lines
• Data analytic skills
• Operational proficiency with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills

Preferred Qualifications

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

To all current Molina employees: 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.

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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

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