Director, Provider Engagement (Seattle, Washington)

JOB DESCRIPTION

Work Location – Bothell, WA

Supports the Washington health plan in the development and implementation of State-wide initiatives and projects supporting provider engagement for all business segments, related to Quality and Risk Adjustment.  Responsible for continuous quality improvements.  Supports robust provider engagement to achieve positive operational and financial outcomes. Leads Provider Engagement team to effective and meaningful performance improvement within the assigned providers for engagement.

Molina’s Provider Engagement function implements Health Plan provider engagement strategy  to achieve positive quality and financial performance outcomes through effective provider engagment activities. This position shall serve as the subject matter expert in Quality/HEDIS measures, Data Management & Reporting, Risk Adjustment and evaluating the quality components of value-based reimbursement models.

KNOWLEDGE/SKILLS/ABILITIES

Under leadership of the AVP, Health Plan Quality Improvement & Risk Adjustment, the Director develops and implements the Provider Engagement strategy related to Quality and Risk Adjustment and is responsible to manage day-to-day work related to VBC contracts and provider relationships across the network – address issues, develop and provide education, facilitate meeting to achieve established goals related to Quality and Risk Adjustment.

 

• Lead assigned Provider Engagement Managers and/or Provider Engagement Sr. Specialists team.  Manages, coaches and trains staff as needed to ensure successful execution and outcomes.
• Supports provider organizations and ensures providers understand and achieve shared Quality goals (may be VBC).
• If applicable by Health Plan, engages with Providers to attain high performance in VBCs.
• Ensuring adherence to approved, educational materials. Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes. 
• Collaborates with provider partners to improve quality performance and risk adjustment accuracy through consistent provider meetings and collaboration activities with the highest level of compliance. 
• Monitors and analyzes Provider reporting and produces meaningful action-oriented insights for Providers. 
• Coaches providers on how to identify performance opportunities, improve quality performance and reduce cost of care. 
• Monitors and measures key performance indicators and milestones
• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement, risk adjustment and population health management functions including Provider Action Plans. 
• Collaborates with Health Plan Network to support value-based care strategy. 
• Ensure staff use a Standardized Provider Engagement “Tool Kits”, training program and deployment plan.  Implement approaches to determining outcomes of tools and training programs. 
• Monitor key metrics to determine Provider Engagement effectiveness and success (e.g. Quality Partner Programs, use of the Molina Provider Collaboration Portal, Provider submission of supplemental data, scorecard performance, etc.)                                                                                                                 
• Is a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals 
• Accountable for documentation of activity in national tool (Salesforce) and ongoing monitoring of of performance for each assigned provider and to meet Center of Excellence expectations. 
• Accountable for consistent use of defined, approved templates for external facing materials as well as Health Plan Provider Engagement-specific document creation, approval, and maintenance. 
• Collaborates with internal teams to best support provider execution and outcomes within participating Molina programs.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
• Communicates comfortably and effectively with all levels of a healthcare organization, within both the corporate and r