Molina Healthcare
Specialist, Provider Engagement (must reside in South Carolina - upstate or low
Molina Healthcare, Rock Hill, South Carolina, United States, 29732
Specialist, Provider Engagement (must reside in South Carolina - upstate or low country)
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Specialist, Provider Engagement (must reside in South Carolina - upstate or low country)
role at
Molina Healthcare
The Provider Engagement Specialist role implements the Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. It ensures Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals, drives coaching and collaboration with providers, addresses practice environment challenges, and tracks engagement activities using standard tools.
Job Duties
Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & 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 provides solutions to improve health outcomes.
Promotes 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.
Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness.
Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
Uses standard Molina Provider Engagement reports and training materials.
Facilitates connectivity to internal partners to support data exchanges, documentation education, and patient engagement activities.
Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
Communicates effectively with physician leaders, providers, practice managers, and medical assistants within assigned provider practices.
Maintains the highest level of compliance.
Travel may be required; 0–80% of time out of office, depending on location.
Job Qualifications Required Qualifications
Associate’s degree or equivalent combination of education and work experience.
1–3 years experience in healthcare with at least 1 year improving provider quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
Working knowledge of quality metrics and risk adjustment practices across all business lines.
Data analytic skills.
Operational knowledge and experience with PowerPoint, Excel, Visio.
Effective communication skills.
Strong leadership skills.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $43,121 – $88,511.46 / ANNUAL. Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Seniority Level Entry level
Employment Type Full-time
Job Function Other
Industry Hospitals and Health Care
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Specialist, Provider Engagement (must reside in South Carolina - upstate or low country)
role at
Molina Healthcare
The Provider Engagement Specialist role implements the Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. It ensures Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals, drives coaching and collaboration with providers, addresses practice environment challenges, and tracks engagement activities using standard tools.
Job Duties
Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & 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 provides solutions to improve health outcomes.
Promotes 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.
Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness.
Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
Uses standard Molina Provider Engagement reports and training materials.
Facilitates connectivity to internal partners to support data exchanges, documentation education, and patient engagement activities.
Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
Communicates effectively with physician leaders, providers, practice managers, and medical assistants within assigned provider practices.
Maintains the highest level of compliance.
Travel may be required; 0–80% of time out of office, depending on location.
Job Qualifications Required Qualifications
Associate’s degree or equivalent combination of education and work experience.
1–3 years experience in healthcare with at least 1 year improving provider quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
Working knowledge of quality metrics and risk adjustment practices across all business lines.
Data analytic skills.
Operational knowledge and experience with PowerPoint, Excel, Visio.
Effective communication skills.
Strong leadership skills.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $43,121 – $88,511.46 / ANNUAL. Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Seniority Level Entry level
Employment Type Full-time
Job Function Other
Industry Hospitals and Health Care
#J-18808-Ljbffr