Senior Specialist, Health Plan Provider Engagement
New
M
Molina HealthcareHealthcare quality
Source API remote eligibility restrictions: United States; Remote in NMFull-TimeSenior
Salary not disclosed
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Job Details
- Experience
- 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.
- Required Skills
- Microsoft Power BIMicrosoft Excel
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 business lines.
- Knowledge 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, attention to detail, and organizational skills.
- Ability to implement process improvement initiatives, drive change, and work independently in a fast-paced, deadline-driven environment.
- Ability to build relationships across 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 programs, with the ability to learn new information systems and software.
- A bachelor's degree in Nursing, Health Administration, or a relevant discipline is preferred.
- Understanding of health insurance, provider messaging/design, and project management is preferred.
- Strong experience with Microsoft products, including Excel pivot tables and VLOOKUP, and PowerPoint is preferred.
Responsibilities
- Support provider engagement activities, value-based strategies, and risk adjustment and quality improvement initiatives.
- Develop provider engagement plans to help assigned providers meet annual quality and risk adjustment goals.
- Coach providers and collaborate with them through meetings, action items, and execution to improve quality performance and risk adjustment accuracy.
- Work with provider front-office staff to schedule members with open care gaps and coordinate supporting efforts with Health Plan Community and Member Engagement resources.
- Address practice environment barriers that impede program goals and health outcomes.
- Drive provider participation in risk adjustment and quality initiatives, including supplemental data, EMR connections, clinical profiles programs, and the provider collaboration portal.
- Track engagement and training activities using standard provider engagement tools and reports.
- Collaborate with health plan and shared service partners, including Provider Relations Network team members, on business goals and provider and member issues.
- Develop, organize, analyze, document, and implement processes and procedures in line with health plan and corporate policies.
- Train and support new and existing practice transformation and provider engagement team members.
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