Manager, Provider Quality & Practice Transformation (Remote IA)

Company: Molina Healthcare
Location: Iowa City
Posted on: January 23, 2023

Job Description:

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. - Pay Range: -$66,456.22 - $129,589.63 a year* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. #PJAF #LI-Remote

Keywords: Molina Healthcare, Iowa City , Manager, Provider Quality & Practice Transformation (Remote IA), Executive , Iowa City, Iowa