Senior Specialist, Health Plan Provider Engagement (Remote in KY)

Molina Healthcare•Long Beach, KY

7d•Remote

About The Position

Provides senior-level support for health plan provider engagement strategies and activities to drive quality and risk adjustment outcomes. Uses a consultative approach that emphasizes physician engagement and behavior change through actionable data and analytics, supporting value-based care strategies through risk adjustment and quality improvement activities. The role ensures assigned Tier 1 and Tier 2 providers—and, where applicable, Tier 3 providers—have engagement plans to meet annual quality and risk adjustment goals. It coaches and collaborates with providers through regular meetings and action plans, addresses practice-environment challenges, tracks engagement activities, facilitates data exchanges, and supports training and problem resolution. The position drives provider participation in Molina’s risk adjustment and quality initiatives and maintains compliance. Same-day out-of-office travel may be required up to 80% of the time, depending on state and health plan requirements.

Requirements

At least 3 years of experience improving population-level HEDIS quality scores and burden-of-illness documentation accuracy through provider engagement, or an equivalent combination of relevant education and experience.
Experience with managed health care provider compensation methodologies, including fee-for-service, value-based care, and capitation.
Working knowledge of quality metrics and risk adjustment practices across all business lines.
Knowledge and understanding of HEDIS/NCQA and/or CMS STARs quality measures and risk adjustment practices across Medicaid, Medicare, and Marketplace.
Proficiency in data analysis, manipulation, interpretation, and reporting.
Critical-thinking, problem-solving, and analytical skills.
Relationship-building skills.
Attention to detail and organizational skills.
Ability to implement process-improvement initiatives and drive change.
Ability to work independently in a fast-paced, deadline-driven environment.
Ability to build relationships in a cross-functional, highly matrixed organization to obtain buy-in and drive results.
Effective verbal and written communication skills.
Proficiency with Microsoft Office, including Excel, Power BI, and other applicable software; ability to learn new information systems and software programs.

Nice To Haves

Bachelor’s degree in Nursing, Health Administration, or a relevant discipline.
Solid understanding of health insurance, provider messaging/design, and project management.
Strong experience using Microsoft products, including Excel features such as pivot tables and VLOOKUP, and PowerPoint.

Responsibilities

Support provider engagement activities, including value-based strategies and risk adjustment and quality improvement initiatives.
Ensure assigned Tier 1 and Tier 2 providers, and where applicable Tier 3 providers, have engagement plans to meet annual quality and risk adjustment performance goals.
Coach and collaborate with provider partners to improve Medicaid, Medicare, and Marketplace quality performance and risk adjustment accuracy through consistent meetings and development and execution of action items.
Work with provider front-office staff to schedule Molina members with the most open care gaps with their assigned provider.
Coordinate with Health Plan Community and Member Engagement resources to support member-side efforts.
Address practice-environment challenges and barriers to program goals and identify solutions to improve health outcomes.
Drive provider participation in Molina risk adjustment and quality efforts, including supplemental data, EMR connections, clinical profile programs, and use of the Molina provider collaboration portal.
Track engagement and training activities with standard provider engagement tools and measure effectiveness within and across Molina health plans.
Serve as a provider engagement subject matter expert and collaborate with health plan and shared service partners to align with business goals.
Collaborate with the assigned health plan Provider Relations Network team member on operational, provider, and member issues.
Use standard Molina Provider Engagement reports and training materials.
Develop, organize, analyze, document, and implement processes and procedures in accordance with health plan and corporate policies.
Communicate with internal and external stakeholders, including physician leaders, providers, practice managers, and medical assistants.
Provide training and support to new and existing practice transformation and provider engagement team members.
Maintain the highest level of compliance.