Specialist, Provider Engagement (Remote in TX)

JOB DESCRIPTION Job Summary The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers 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. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies. Job Duties u2022 Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals. u2022 Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution. u2022 Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes. u2022 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. u2022 Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans. u2022 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. u2022 Accountable for use of standard Molina Provider Engagement reports and training materials. u2022 Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities. u2022 Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies. u2022 Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices. u2022 Maintains the highest level of compliance. u2022 This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location. JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: u2022 Associateu2019s degree or equivalent combination of education and work experience. u2022 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience. u2022 Working knowledge of Quality metrics and risk adjustment practices across all business lines u2022 Demonstrates data analytic skills u2022 Operational knowledge and experience with PowerPoint, Excel, Visio u2022 Effective communication skills u2022 Strong leadership skills

Created: 2025-09-19