JOB DESCRIPTION
Job Summary
Responsible for continuous quality improvements and risk adjustment accuracy for all government lines of business. Supports robust provider engagement to achieve positive operational and financial outcomes.
KNOWLEDGE/SKILLS/ABILITIES
- Establishes the strategy and operational direction for provider engagement and practice transformation, in collaboration with the Plan President, network and operations staff for larger value based contracted provider organizations.
- Provides strategic direction for provider quality and practice transformation specialists to help providers understand how to improve quality and progression toward meeting value-based purchasing goals and assesses provider readiness for higher levels on the value-based purchasing continuum.
- Ensures health plan provider engagement stakeholders are engaged and prepared to report quarterly updates at the meetings and overall, to health plan Senior Leadership Team meetings.
- Leads one or more teams from multiple disciplines (Quality, Provider Services, Clinical, Operations) to engage with key providers.
- Participates in state level quality and risk adjustment strategy meetings, develops a quality workplan, and ensures integration of quality and risk adjustment into the overall business process.
- Has overall responsibility for the content, maintenance and access to the Health Plan provider quality and practice transformation SharePoint site.
- Builds internal relationships to develop a team approach to provider engagement.
- Builds and nurture positive relationships between strategic providers and Plan.
- Reports on strategic provider results (e.g., changes in quality outcomes, financial results, etc.) on periodic basis to Senior Leadership Team.
JOB QUALIFICATIONS
Required Education:
Bachelor’s Degree or equivalent combination of education and experience.
Required Experience:
- Min 5 years’ experience in managed healthcare administration and/or Provider Services.
- Provider contract network development & management experience
- Project management experience, in a managed healthcare setting
- Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid, Marketplace and Medicare lines of business, including but not limited to fee-for service, capitation and various forms of risk, ASO, etc.
Preferred Education:
Master’s Degree
Preferred Experience:
- Experience with risk adjustment and quality metrics with government business lines of business.
- Previous provider relationship and engagement preferred
- Experience with Value Based Contract arrangements, and provider engagement
Preferred License, Certification, Association:
RN license
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.
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Pay Range: $59,810.6 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
