Sr. Specialist, Quality Provider Engagement- RN / LPN Preferred (Remote)

Lensa; Biloxi (MS); Remote; USD 60,000 - 100,000; Full time

Job summary

An innovative healthcare firm is seeking a Sr. Specialist in Provider Engagement to enhance quality and risk adjustment outcomes. This dynamic role involves coaching Tier 2 and Tier 3 providers, addressing practice challenges, and ensuring compliance with policies. The ideal candidate will have a Bachelor's degree and a minimum of 3 years of experience in provider engagement or managed care quality improvement. With a focus on effective communication and collaboration, this position offers the opportunity to make a significant impact in healthcare delivery while potentially traveling up to 80% of the time. If you're passionate about improving health outcomes, this role is for you.

Qualifications

• 3+ years experience in provider engagement or managed care quality improvement.
• Strong knowledge of Quality metrics and risk adjustment practices.

Responsibilities

• Drive provider coaching and collaboration to improve quality and risk adjustment accuracy.
• Ensure assigned providers have engagement plans to meet performance goals.

Skills

Provider Engagement

Communication Skills

Leadership Skills

Healthcare Knowledge

Quality Metrics Knowledge

Education

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

Tools

PowerPoint

Excel

Visio

Job description

Sr. Specialist, Quality Provider Engagement- RN / LPN Preferred (Remote)

The Sr. Specialist, Provider Engagement role implements the Health Plan's provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. The role ensures that Tier 2 providers in the Health Plan have engagement plans to meet annual quality and risk adjustment goals. It involves coaching and collaborating with providers to improve performance, addressing practice environment challenges, tracking engagement activities, and maintaining compliance with policies. The position requires excellent communication skills and may involve travel up to 80% depending on location.

Job Duties

1. Ensure assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet performance goals.
2. Drive provider coaching and collaboration to improve quality and risk adjustment accuracy.
3. Address challenges in the practice environment to improve health outcomes.
4. Encourage provider participation in Molina's risk adjustment and quality initiatives.
5. Track engagement activities using standard tools to measure effectiveness.
6. Serve as a subject matter expert in Provider Engagement.
7. Assist with training and issue escalation.
8. Use standard reports and training materials effectively.
9. Facilitate data exchanges and support documentation and patient engagement activities.
10. Develop and implement processes in line with policies.
11. Communicate effectively with healthcare professionals.
12. Maintain high compliance standards.
13. This role may require travel up to 80% depending on location.

Job Qualifications

Required:

• Bachelor’s degree in Business, Healthcare, Nursing, or related field or equivalent experience.
• Minimum of 3 years experience in provider engagement, practice transformation, or managed care quality improvement.
• Experience with healthcare provider compensation methodologies.
• Knowledge of Quality metrics and risk adjustment practices.
• Operational proficiency with PowerPoint, Excel, Visio.
• Strong leadership skills.

Preferred:

• At least 3 years experience improving Quality performance for Medicaid, Medicare, or ACA Marketplace programs.