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

Employer Industry: Healthcare

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive benefits and compensation package
- Chance to make a positive impact on quality and risk adjustment outcomes
- Collaborative work environment with healthcare professionals
- Frequent engagement with providers to enhance performance
- Position may require same-day out-of-office travel approximately 0-80% of the time

What to Expect (Job Responsibilities):
- 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
- Address challenges in the practice environment to achieve program goals and improve health outcomes
- Track all engagement and training activities using standard tools to measure effectiveness
- Facilitate connectivity to internal partners to support data exchanges and patient engagement activities

What is Required (Qualifications):
- Bachelor’s degree in Business, Healthcare, Nursing, or related field, or equivalent combination of education and relevant experience
- Minimum 3 years of experience improving provider quality performance through engagement, practice transformation, or managed care quality improvement
- Experience with various managed healthcare provider compensation methodologies, including fee-for-service and value-based care
- Strong working knowledge of quality metrics and risk adjustment practices across all business lines
- Effective communication and strong leadership skills

How to Stand Out (Preferred Qualifications):
- Minimum 3 years of experience improving quality performance for Medicaid, Medicare, and/or ACA Marketplace programs

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