Enable job alerts via email!
Sr. Specialist, Quality Provider Engagement- RN / LPN Preferred (Remote)
Lensa
Gulfport (MS)
Remote
USD 49,000 - 108,000
Full time
Boost your interview chances
Create a job specific, tailored resume for higher success rate.
Job summary
An established industry player is seeking a Sr. Specialist in Quality Provider Engagement to enhance provider performance and ensure compliance with healthcare standards. This role is pivotal in driving engagement strategies that lead to improved quality and risk adjustment outcomes. You will collaborate closely with healthcare professionals, addressing challenges in practice environments while tracking engagement activities. If you have a passion for healthcare and a knack for data analysis, this opportunity allows you to make a significant impact in a remote work setting, contributing to better health outcomes for communities.
Qualifications
- 3+ years of experience in provider engagement and quality improvement.
- Strong knowledge of managed healthcare compensation methodologies.
- Operational knowledge of quality metrics and risk adjustment practices.
Responsibilities
- Develop and implement provider engagement plans for quality performance.
- Drive coaching and collaboration with providers to improve outcomes.
- Track engagement activities and facilitate data exchanges.
Skills
Education
Tools
Job description
Molina Healthcare
Morgan Stephens
Stability Healthcare
Morgan Stephens
Mayo Clinic
MEDSTAR HEALTH
Children's Health
Children's Health
Children's Health
UCHealth
St. Luke's Health System
Children's Health
Children's Health
Healthfirst
Mayo Clinic
Ochsner Health System
St. Luke's Health System
Providence Health and Services
Lakeland Care, Inc.
Morgan Stephens
The Sr Specialist, Provider Engagement role implements 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.
• Assist 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 upon location.
Job Qualifications
REQUIRED QUALIFICATIONS:
• Bachelor’s degree in Business, Healthcare, Nursing or related field or equivalent combination of education and relevant experience
• Min 3 years experience 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 but not limited to: fee-for service, value-based care, and capitation
• Strong working knowledge of Quality metrics and risk adjustment practices across all business lines
• Operational knowledge and experience with PowerPoint, Excel, Visio
• 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: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCorp
#LI-AC1
Pay Range: $49,430.25 - $107,098.87 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
RN - Home Care for Scottsdale area (Full Remote) Pay: $110,000 - $125,000 Full-time / Remote - Field Position Overview: We are actively seeking a committed and empathetic Registered Nurse (RN) in Scottsdale, AZ to join our team, offering a full-time position. In this role, you will be instrumental...
Stability Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Walnut Creek, California. Specialty: Case Management ~ Discipline: RN ~ Shift: 8 hours, days, flexible ~ Employment Type: Travel *$600 travel bonus *Day 1 health insurance with United Healthcare *PTO plan...
Home Health Opportunities Across California Morgan Stephens - A Leader in Healthcare Recruitment Morgan Stephens is proud to partner with some of the largest medical systems and managed care organizations to offer exciting home health opportunities throughout California. We are actively recruiting...
Mayo Clinic is seeking a Registered Nurse (RN) Med Surg for a nursing job in Rochester, Minnesota. Job Description & Requirements Specialty: Med Surg Discipline: RN Start Date: ASAP Duration: Ongoing Employment Type: Staff Upon successful orientation completion and integration into the...
General Summary of Position Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services, procedures and facilities. Responsible for clinical review of acute care services based on Medically Necessity criteria, the management of quality health care...
Children's Health (Dallas) is seeking a Registered Nurse (RN) Clinic Manager, Program Manager for a nursing job in Dallas, Texas. Job Description & Requirements Specialty: Program Manager Discipline: RN Duration: Ongoing Employment Type: Staff Job Title & Specialty Area: Program Manager Continuing...
Children's Health (Dallas) is seeking a Registered Nurse (RN) Clinic for a nursing job in Dallas, Texas. Job Description & Requirements Specialty: Clinic Discipline: RN Duration: Ongoing Employment Type: Staff Why Children’s Health? At Children's Health, our mission is to Make Life Better for...
Children's Health (Dallas) is seeking a Registered Nurse (RN) Care Manager for a nursing job in Dallas, Texas. Job Description & Requirements Specialty: Care Manager Discipline: RN Duration: Ongoing Employment Type: Staff Job Title & Specialty Area: Registered Nurse - Care Coordinator Department:...
UCHealth (Colorado) is seeking a Registered Nurse (RN) Float Manager, Behavioral Health for a nursing job in Aurora, Colorado. Job Description & Requirements Specialty: Behavioral Health Discipline: RN Duration: Ongoing 36 hours per week Employment Type: Staff Description Location: UCHealth UCHlth...
St. Luke's Health System is seeking a Registered Nurse (RN) Manager, Telehealth for a nursing job in Boise, Idaho. Job Description & Requirements Specialty: Telehealth Discipline: RN Duration: Ongoing 36 hours per week Shift: 12 hours Employment Type: Staff Overview At St. Luke’s, our dedicated...
Children's Health (Dallas) is seeking a Registered Nurse (RN) Electrophysiology Lab for a nursing job in Dallas, Texas. Job Description & Requirements Specialty: Electrophysiology Lab Discipline: RN Duration: Ongoing Employment Type: Staff Why Children’s Health? At Children's Health, our mission is...
Children's Health (Dallas) is seeking a Registered Nurse (RN) Clinical Liaison for a nursing job in Dallas, Texas. Job Description & Requirements Specialty: Clinical Liaison Discipline: RN Duration: Ongoing Employment Type: Staff Job Title & Specialty Area: Clinical Liaison Department: Clinical...
You will receive notifications for new jobs in FL . Be the first to see new jobs near FL ! Enter your email address below to be notified when new jobs are posted. By creating an alert, you agree to our Terms . You can change your consent settings at any time as outlined in our Terms. Upload Your...
Mayo Clinic is seeking a Registered Nurse (RN) Med Surg for a nursing job in Rochester, Minnesota. Job Description & Requirements Specialty: Med Surg Discipline: RN Start Date: ASAP Duration: Ongoing Employment Type: Staff Upon successful orientation completion and integration into the...
We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways....
St. Luke's Health System is seeking a Registered Nurse (RN) Administrative for a nursing job in Boise, Idaho. Job Description & Requirements Specialty: Administrative Discipline: RN Duration: Ongoing 36 hours per week Shift: 12 hours Employment Type: Staff Overview Join Our Growing Team as an RN...
Description This phone triage position is per diem/on call/as needed. The Triage RN provides expert geriatric professional, independent nursing care for Providence ElderPlace patients that is as evidence-based as possible. Care is based in the nursing process and is consistent with the Oregon Nurse...
Join our award winning culture as we support members in your area! Position Summary: The part-time Registered Nurse Care Manager (RN CM) Float acts as a temporary member of the interdisciplinary team (IDT) serving frail elders, adults with physical disabilities and adults with...
Job Title: Transitions of Care Nurse (RN or LPN) Location: Remote (Must Reside in Northern Virginia) Pay Rate: $43/hour Employment Type: Temporary Assignment Industry: National Managed Care Organization Position Summary: We are seeking an experienced and compassionate Transitions of Care Nurse (RN...
Description We are hiring Virtual Nurses for a Night shift for .9 Full Time role. Applicants must have their Texas RN license upon hire. Are you an experienced nurse pursuing a new way to apply your clinical expertise with technology? Healthcare is quickly evolving as technology becomes more common...
Sr. Specialist, Quality Provider Engagement- RN / LPN Preferred (Remote)
Job Summary The Sr Specialist, Provider Engagement role implements 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...
'/%3e%3cpath%20d='M101.744%2012.4726L102.894%2016.1947L99.0021%2013.2201L101.744%2012.4726ZM105.3%208.40937H100.488L99.0026%203.59473L97.5116%208.41047L92.7%208.40385L96.5965%2011.3834L95.1055%2016.1942L99.0021%2013.2196L101.408%2011.3834L105.3%208.40992V8.40937Z'%20fill='white'/%3e%3cdefs%3e%3clinearGradient%20id='paint0_linear_5593_1381'%20x1='90'%20y1='9.44471'%20x2='99'%20y2='9.44471'%20gradientUnits='userSpaceOnUse'%3e%3cstop%20stop-color='%2300AD70'/%3e%3cstop%20offset='0.998594'%20stop-color='%2300B67A'/%3e%3cstop%20offset='1'%20stop-color='%23DCDCE6'/%3e%3c/linearGradient%3e%3c/defs%3e%3c/svg%3e){kind=small}
job faster
