Health Plan Provider Engagement Manager; Remote in KY

Job Description

Provides subject matter expertise and leadership for health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. 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 the health plan's largest and most impactful providers with the most complex value-based contracts have engagement plans to 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 achieve program goals and improve health outcomes.

• Provides support for provider engagement activities including enhancing value-based strategies and risk adjustment/quality improvement initiatives.
• Ensures assigned Tier 1 providers have a provider engagement plan to meet annual quality and risk adjustment performance goals; may engage Tier 2 providers as needed.
• Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development, and execution.
• Works with provider front-office staff to get the Molina members with the most open gaps on the schedule seen by their assigned provider. Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side.
• Addresses challenges/barriers in the practice environment impending successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g., supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
• Mentors and assists Provider Engagement Specialists and Senior Specialists with training and problem escalation.
• Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness.
• Works collaboratively with health plans and shared service partners to ensure alignment to business goals.
• 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 internal and external stakeholders, including physician leaders, providers, practice managers, and medical assistants within 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.

• Provides support for provider engagement activities including enhancing value-based strategies and risk adjustment/quality improvement initiatives.
• Ensures assigned Tier 1 providers have a provider engagement plan to meet annual quality and risk adjustment performance goals; may engage Tier 2 providers as needed.
• Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development, and execution.
• Works with provider front-office staff to get the Molina members with the most open gaps on the schedule seen by their assigned provider. Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side.
• Addresses challenges/barriers in the practice environment impending successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g., supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
• Mentors and assists Provider Engagement Specialists and Senior Specialists with training and problem escalation.
• Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness.
• Works collaboratively with health plans and shared service…