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

Lensa; Gulfport (MS); Remote; USD 70,000 - 90,000; 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. The role involves collaborating with healthcare professionals, tracking engagement activities, and ensuring compliance with policies. Ideal candidates will have a Bachelor's degree and experience in improving provider performance. This position may require significant travel.

Qualifications

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

Responsibilities

• Ensures assigned providers have a Provider Engagement plan.
• Drives provider coaching and collaboration to improve quality.
• Tracks engagement and training activities using standard tools.

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- RN / LPN Preferred (Remote)

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!

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 Tier 2 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through meetings and action plans. Addresses practice environment challenges to meet program goals and improve health outcomes. Tracks engagement activities, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains policy compliance.

Job Duties

1. Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet performance goals.
2. Drives provider coaching and collaboration to improve quality and risk adjustment accuracy through meetings and action plans.
3. Addresses challenges in the practice environment impeding program goals and seeks solutions to improve health outcomes.
4. Encourages provider participation in Molina risk adjustment and quality efforts and use of the Provider Collaboration Portal.
5. Tracks all engagement and training activities using standard tools to measure effectiveness.
6. Serves as a Provider Engagement subject matter expert, collaborating within the Health Plan and with shared service partners to align with business goals.
7. Assists Provider Engagement Specialists with training and problem escalation.
8. Uses standard Molina Provider Engagement reports and training materials.
9. Facilitates connectivity with internal partners for data exchanges, documentation education, and patient engagement activities.
10. Develops and implements processes and procedures per policies.
11. Communicates effectively with Physician Leaders, Providers, Practice Managers, and Medical Assistants.
12. Maintains high compliance standards.
13. This position may require travel up to 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 engagement, practice transformation, or quality improvement.
• Experience with healthcare provider compensation methodologies including fee-for-service, value-based care, and capitation.
• Strong knowledge of Quality metrics and risk adjustment practices.
• Data analytic skills.
• Operational knowledge of PowerPoint, Excel, and Visio.
• Effective communication skills.
• Strong leadership skills.

Preferred Qualifications

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

Current Molina employees should apply through the intranet. Molina offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Additional Details

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