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As part of Molina’s response to the COVID-19 pandemic, unless otherwise prohibited by law, new hires with a start date of November 1, 2021 or later will be required to be fully vaccinated.

Manager, Provider Quality & Practice Transformation

Molina Healthcare Reno, Nevada Job ID 2009532
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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.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

PREFERRED EDUCATION:

Master’s Degree

PREFERRED EXPERIENCE:

  • Experience with risk adjustment and quality metrics with governement 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.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 08/05/2021

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