Job Description 
 

Job Summary 
 

The Program Manager, Provider Engagement Programs is part of our innovative WA Quality & Risk Adjustment department to assist our diverse team of data leaders, quality & risk adjustment experts, and developers in the development and implementation of business strategies, operations and vendor management related to provider engagement activities in all government lines of business impacted by the regulatory risk adjustment payment model.

They will be accountable for implementing and managing provider engagement programs that lead to the overall achievement of improved quality outcomes and risk score accuracy, compliancy and completeness in risk adjustment revenue for all government lines of business to better support overall population heath management, reduce gaps in care and drive medical loss ratio (MLR) targets. In conjunction with Quality Market & Segment leadership, this role supports the strategic direction and organization of corporate initiatives to facilitate achievement of the provider engagement programs. This position shall serve as the subject matter expert in Quality/HEDIS measures, HEDIS Operations, Data Management and Reporting, Risk Adjustment and Value Based Care.   Manages assigned provider relationships across the network – address issues, develop and provide education and facilitate meeting established goals.

  Knowledge/Skills/Abilities 
 

This role interacts and supports regulatory agency policy and procedures by acting as a key business partner to Market & Segment leaders and some or all of the following teams:  corporate quality team, corporate provider network team, health plan teams, external vendors, actuary, and finance. The position's essential functions are as follows:

 

Collaborates with colleagues to implement and manage provider engagement program initiatives such as provider education/engagement and provider incentives. Facilitates and actively participates in program discussions and activities with internal and external providers. Supports, educates and equips strategic providers with information and tools for success provides practice management resources and assistance. Addresses challenges/barriers in the practice environment impeding successful attainment of program goals. Collaborates with contracted vendors and colleagues to develop and implement provider education/engagement in risk adjustment models to better align with clinical documentation requirements, value-based payment programs and/or provider performance programs. Responsible for tracking and monitoring success of provider engagement program initiatives against set goals, develops corrective action plans for program and partnering vendors, communicates program progress. Responsible for communicating provider engagement activities to key stakeholders such as provider network teams and health plan teams. Develops and maintains program work plans, workflows, and related program documentation. Develops and implements efficiency measures that are consistent and supportive of the strategic plans. Develops, tracks and reports key performance measures. Maintains compliance with all policies and procedures. Adheres to all confidentiality and HIPAA requirements as outlined within Policies and Procedures in all ways and at all times with respect to any aspect of the data handles or services rendered in the undertaking of the position. Fulfills those responsibilities and/or duties that may be reasonably provided by Molina for the purpose of achieving operational and financial success of the Company..

  Job Qualifications

Required Education
• Minimum Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience
Required Experience
• 3-5 years managed care experience, preferably with a national or multi-location organization
• Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliancy
• Proven ability to innovate and drive organizational change
• Excellent presentation and communication skills
Preferred Education
Graduate Degree preferred

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.