Molina Healthcare
Job Description
Job Summary
The Manager, Provider Engagement establishes strategies and operational directions for risk adjustment and quality improvement. Collaborates with senior leadership and the Health Plan Network to drive value-based care strategies. Sets and manages performance goals, ensuring providers meet quality and risk adjustment targets through coaching and consistent engagement. Tracks and measures the effectiveness of engagement activities, driving provider participation in Molina’s risk adjustment and quality initiatives. Facilitates data exchanges and documentation education, while assessing and training team members to ensure competency.
Job Duties
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Leads team of Provider Engagement resources.
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Establishes strategy and operational direction for engaging providers on risk adjustment & quality improvement in collaboration with the Plan President, AVP of Quality & Risk Adjustment, and Network team.
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Collaborates with Health Plan Network to drive value-based care strategy related to risk adjustment & quality.
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Sets Health Plan level performance goals and manages progress for key performance indicators.
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Ensures each Tier 1, Tier 2 and Tier 3 provider has quality & risk adjustment performance goals and execution plans to meet committed goals, with emphasis on Tier 1 and Tier 2.
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Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
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Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
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Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans.
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Drives provider participation in Molina risk adjustment and quality efforts (e.g., Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal.
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Is a Provider Engagement subject matter expert; works collaboratively within the Health Plan and across Molina’s Centers of Excellence and Shared Services to drive improved risk adjustment and quality of care.
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Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
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Assesses Provider Engagement team members across required competency matrix and ensures they receive needed training on any lagging competencies.
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Ensures Provider Engagement team uses standard Molina Provider Engagement reports and training materials.
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Develops, organizes, analyzes, documents, and implements processes and procedures as prescribed by Plan and Corporate policies.
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Communicates comfortably and effectively with all levels of a healthcare organization, within both the corporate and regional market environments and with external provider partners.
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Maintains the highest level of compliance.
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This position may require same day out of office travel approximately 30% of the time, depending upon location.
Job Qualifications
REQUIRED QUALIFICATIONS:
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Bachelor’s degree in Business, Healthcare, Nursing or related field or equivalent combination of education and relevant experience.
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5-7 years of experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience
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Experience with various managed healthcare provider compensation methodologies including but not limited to: fee-for service, value-based care, and capitation
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Strong working knowledge of Quality metrics and risk adjustment practices across all business lines
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Demonstrates data analytic skills
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Operational knowledge and experience with PowerPoint, Excel, Visio
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Effective communication skills
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Strong leadership skills
PREFERRED QUALIFICATIONS:
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People management experience
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Min 5 years’ experience improving provider Quality performance through provider engagement for Medicaid, Medicare, and/or ACA Marketplace programs
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $73,102 – $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
