56 applicantsPosted by Agency

Company

Molina Healthcare · 2 days ago

Specialist, Provider Quality & Practice Transformation (Remote in Nevada)

Las Vegas, NV

Full-time

Remote

Mid Level

$52K/yr - $102K/yr

3+ years exp

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Responsibilities

Implements key quality and population health strategies and risk adjustment, alongside providers and with direction from the Mgr., Provider Quality and Practice Transformation and Health Plan Leadership, to engage and empower members and impact health outcomes; may include initiation and management of provider interventions (e.g., removing barriers to care.)

Helps practices to identify areas of need and helps with efficiency measures to improve availability, through sharing of scorecards, delivering gaps-in-care information and risk reports, sharing of satisfaction results as applicable, and delivering other critical operational and efficiency reports.

Coaches practices on how to improve quality and progression toward meeting value-based purchasing goals and works with Health Plan Leadership and Network to assess provider readiness for higher levels on the value-based purchasing continuum.

Collaborates with strategic practices and provider sites, including primary care providers and specialists, to identify potential utilization trends and compliance with appointment timeliness standards.

Facilitates provider engagement meetings, including meeting agendas, minutes, handouts, and monitoring action items to completion.

Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.

Creates, manages, and/or compiles the required documentation to maintain critical quality improvement, risk adjustment and population health management functions.

Leads quality improvement activities and risk adjustment accuracy meetings and discussions with and between other departments within the organization or with and between key provider network partners.

Evaluates project/program activities and results to identify opportunities for improvement.

Surfaces to Manage any gaps in processes that may require remediation.

Completes other tasks, duties, projects, and programs as assigned.

This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location.

This position may require multiple day out of town overnight travel approximately on occasion, depending upon location.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Quality ImprovementRisk AdjustmentHealthcare ExperienceBusiness WritingExcelVisioMedicare ExperienceMedicaid ExperienceCertified Professional in Health Quality (CPHQ)Nursing License (RN)

Required

Bachelor's Degree or equivalent combination of education and work experience.

Min. 3 years’ experience in healthcare with 1 year experience in health plan quality improvement, and/or risk adjustment managed care or equivalent experience.

Demonstrated solid business writing experience.

Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred

Preferred field: Clinical Quality, Public Health or Healthcare.

1 year of experience in Medicare and in Medicaid.

Certified Professional in Health Quality (CPHQ)

Nursing License (RN may be preferred for specific roles)

Company

Molina Healthcare

Glassdoor

3.4

Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.

Founded in 1980

Long Beach, California, USA

10001+ employees

https://careers.molinahealthcare.com

H1B Sponsorship

Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (33)

2022 (36)

2021 (33)

2020 (60)