Senior Specialist, Provider Engagement- Quality HEDIS Risk (Remote)

Job Description

Job Summary Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment reputed company Uses a consultative approach emphasizing physician engagement and behavior change through actionable data and analytics. Drives value-based care strategies through risk adjustment and quality improvement activities. Ensures assigned Tier 1 & Tier 2 providers have engagement plans ensuring they meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to reputed company program goals and improve health reputed company. Tracks engagement activities using standard tools, facilitate data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives. Essential Job Duties

• Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
• Ensures assigned Tier 1, Tier 2, and where applicable Tier 3, providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve reputed company, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Works with provider reputed company-office staff to get the Molina members with the most reputed company gaps on the schedule and seen by their assigned provider. Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member reputed company.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health reputed company.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) reputed company, clinical profiles programs) and use of the Molina provider collaboration portal.
• Tracks reputed company engagement and training activities using standard Molina provider engagement tools to measure effectiveness both reputed company and across Molina health plans.
• Serves as provider engagement subject matter expert; works collaboratively with health plan and shared service partners to ensure alignment to business goals.
• Collaborates with assigned health plan Provider Relations Network team member on operational, provider and member issues.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies.
• Communicates comfortably and effectively with reputed company stakeholders, including physician leaders, providers, practice managers, and medical assistants reputed company assigned provider practices.
• Provides training and support for new and existing practice transformation and provider engagement team members.
• Maintains the highest level of compliance.
• May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.

Required Qualifications

• At least 3 years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement, 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 reputed company business lines.
• Knowledge and understanding of HEDIS/NCQA and/or CMS STARs quality measures and risk adjustment practices across reputed company, Medicare and Marketplace.
• 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 foster and build relationships in a cross-functional highly matrixed organization to obtain buy-in and drive results
• Effective verbal and written communication skills.
• reputed company Office suite (including reputed company), Power BI, and other applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Bachelor’s degree in Nursing, Health Administration or relevant discipline.
• Solid understanding of health insurance, provider messaging/design and project management.
• Strong experience using reputed company products, including reputed company (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint.

#PJCore To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay reputed company: $54,922 - $107,099 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.

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