Specialist, Health Plan Quality Practice Transformation

Molina Healthcare•Long Beach, CA

29d•Hybrid

About The Position

Provides support for health plan practice transformation activities. Responsible for implementing health plan provider engagement strategies designed to achieve positive quality and risk adjustment outcomes. Drives engagement to ensure assigned tier II and tier III providers have practice transformation plans in place carried out to meet annual quality and risk adjustment performance goals.

Requirements

At least 2 years of experience improving provider quality performance through provider engagement, practice transformation, and/or managed care quality improvement initiatives, or equivalent combination of relevant education and experience.
Experience with various managed health care provider compensation methodologies including but not limited to: fee-for service (FFS), value-based care (VBC), and capitation.
Working knowledge of quality metrics and risk adjustment practices across all business lines.
Knowledge and understanding of HEDIS/NCQA.
Proficiency with 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 work in a cross-functional highly matrixed organization.
Effective verbal and written communication skills.
Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Nice To Haves

Experience improving quality performance for Medicaid, Medicare, and/or Marketplace programs.

Responsibilities

Provides support for practice transformation activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
Ensures assigned tier II and tier III providers have a practice transformations plans in place to meet annual quality and risk adjustment performance goals.
Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and recommends solutions required to improve health outcomes.
Drives provider participation in Molina risk ہمارا risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness.
Works collaboratively within the health plan and with shared service partners to ensure alignment to business goals.
Accountable for use of standard Molina practice transformation reports and training materials.
Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies.
Communicates effectively with internal and external stakeholders, including providers, practice managers, and medical assistants within assigned provider practices.
Maintains the highest level of compliance.