Value-Based Provider Engagement Specialist

Molina Talent Acquisition; Long Beach (CA); Remote; USD 70,000 - 100,000; Full time

Job summary

Molina Healthcare is seeking a Provider Engagement Specialist to support implementation of value-based care strategies and risk adjustment initiatives. You will engage Tier 2 and Tier 3 providers, develop engagement plans, and coach providers to improve Medicaid, Medicare and Marketplace quality through regular meetings and action items.

You will collaborate with front-office staff and plan teams, track activities using standard tools, and ensure data exchanges while driving health outcomes and

Qualifications

• 2+ years improving population-level HEDIS quality scores via provider engagement.
• Experience with managed health care provider compensation methodologies (FFS, VBC, capitation).
• Knowledge of quality metrics and risk adjustment practices across Medicaid, Medicare, and Marketplace.
• Familiarity with HEDIS/NCQA and CMS STARs quality measures across programs.

Responsibilities

• Support provider engagement activities to enhance value-based strategies and risk adjustment initiatives.
• Ensure Tier 2 and Tier 3 providers have engagement plans to meet quality and risk goals.
• Coach providers to improve Medicaid/Medicare/Marketplace quality and risk adjustment through meetings and action items.
• Collaborate with provider front-office staff and health plan resources to drive member-focused engagement.
• Address practice environment barriers to achieve program goals and improve outcomes.
• Track engagement and training activities using standard tools; support data exchanges and training.

Skills

Data analysis

Analytical thinking

Communication

Relationship building

Education

Bachelor's degree in Nursing

Tools

Power BI

Excel

Job description

Molina Healthcare is seeking a Provider Engagement Specialist to support implementation of value-based care strategies and risk adjustment initiatives. You will engage Tier 2 and Tier 3 providers, develop engagement plans, and coach providers to improve Medicaid, Medicare and Marketplace quality through regular meetings and action items.

You will collaborate with front-office staff and plan teams, track activities using standard tools, and ensure data exchanges while driving health outcomes and