Value-Based Care Provider Engagement Lead

Molina Healthcare; Jackson (MS); On-site; USD 40,851 - 70,000; Full time

Job summary

Molina Healthcare in Mississippi seeks a Provider Engagement Specialist to support implementation of value-based care strategies for Medicaid, Medicare and Marketplace programs. You will engage Tier 2/3 providers, align engagement plans with annual quality and risk adjustment goals, and coach practices through data-driven action plans.

Working with front-office staff and health plan teams, you will monitor engagement activities, facilitate data exchanges, and help providers improve health

Qualifications

• At least 2 years of experience improving HEDIS quality scores via provider engagement.
• Experience with FFS, value-based care, and capitation.
• Knowledge of quality metrics and risk adjustment practices across Medicaid, Medicare, and Marketplace.
• Familiarity with HEDIS/NCQA and CMS STARs measures across lines of business.
• Proficiency in data analysis, manipulation, and reporting.
• Strong verbal and written communication skills.
• Proficiency with Excel, including pivot tables and VLOOKUP.

Responsibilities

• Provide support for provider engagement activities to enhance value-based strategies.
• Ensure Tier 2/3 providers have engagement plans to meet goals.
• Coach providers to improve Medicaid, Medicare and Marketplace quality and risk adjustment performance.
• Coordinate with provider front-office and health plan teams to schedule provider visits.
• Address practice environment challenges to achieve program goals and improve outcomes.
• Promote provider participation in risk adjustment and quality initiatives.
• Track engagement and training activities using standard tools.
• Collaborate with health plan partners to align to business goals.
• Develop and document processes per policies.

Skills

Data analysis

Critical thinking

Relationship building

Attention to detail

Problem solving

Communication skills

Independent work

Learning new systems

Education

Bachelor's degree in Nursing or Health Administration

Tools

Excel

Power BI

Microsoft Office

Job description

Molina Healthcare in Mississippi seeks a Provider Engagement Specialist to support implementation of value-based care strategies for Medicaid, Medicare and Marketplace programs. You will engage Tier 2/3 providers, align engagement plans with annual quality and risk adjustment goals, and coach practices through data-driven action plans.

Working with front-office staff and health plan teams, you will monitor engagement activities, facilitate data exchanges, and help providers improve health