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

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

Job summary

A leading company in healthcare is seeking a Sr. Specialist in Provider Engagement to implement strategies that enhance quality and risk adjustment outcomes. The role involves developing engagement plans, coaching providers, and ensuring compliance. Candidates should have a Bachelor's degree and relevant experience in provider quality performance. This position may require travel up to 80% of the time.

Qualifications

• Minimum 3 years of experience improving provider quality performance.
• Experience with healthcare provider compensation models.

Responsibilities

• Develop and implement Provider Engagement plans for Tier 2 & Tier 3 providers.
• Coach providers to enhance quality performance and risk adjustment accuracy.
• Track engagement and training activities using standard tools.

Skills

Data analytic skills

Effective communication

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 implements Health Plan provider engagement strategies to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Responsibilities include developing engagement plans for Tier 2 providers, coaching providers to improve performance, addressing practice environment challenges, tracking engagement activities, and ensuring compliance with policies. The role requires effective communication with healthcare professionals and collaboration with internal teams.

Job Duties

• Develop and ensure implementation of Provider Engagement plans for Tier 2 & Tier 3 providers to meet quality and risk adjustment goals.
• Coach and collaborate with providers to enhance quality performance and risk adjustment accuracy through regular meetings and action plans.
• Identify and address challenges in the practice environment that impede program goals and health outcomes.
• Promote provider participation in Molina's risk adjustment and quality initiatives and use of the Provider Collaboration Portal.
• Track engagement and training activities using standard tools to measure effectiveness.
• Serve as a subject matter expert in Provider Engagement, working collaboratively to align with business goals.
• Assist with training and escalate problems as needed.
• Utilize standard reports and training materials to support provider engagement efforts.
• Coordinate with internal partners for data exchanges, documentation, and patient engagement activities.
• Develop and document processes according to policies.
• Communicate effectively with Physician Leaders, Providers, and Practice Managers.
• Maintain high compliance standards.
• Travel may be required 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 of experience improving provider quality performance through engagement and practice transformation.
• Experience with healthcare provider compensation models such as fee-for-service, value-based care, and capitation.
• Strong knowledge of Quality metrics and risk adjustment practices.
• Data analytic skills.
• Operational proficiency with PowerPoint, Excel, and Visio.
• Effective communication and leadership skills.

Preferred Qualifications

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

Interested current Molina employees should apply through the intranet.

Molina Healthcare offers competitive benefits and is an Equal Opportunity Employer.

Additional Details

• Pay Range: $49,430.25 - $107,098.87 annually, depending on location, experience, and skills.
• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Quality Assurance
• Industries: IT Services and IT Consulting