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JOB DESCRIPTION

Job Summary

The Manger, Practice Transformation establishes and implements Health Plan provider engagement strategy to achieve positive quality and financial performance outcomes through effective provider engagement activities. Develops and implements State-wide initiatives and projects supporting practice transformation for all business segments. Responsible for continuous quality improvements. Supports robust provider engagement to achieve positive operational and financial outcomes. Leads Practice Transformation team to effective and meaningful performance improvement within the assigned providers for engagement.

Job Duties

+ Establishes strategy and operational direction for engaging providers on risk adjustment & quality improvement in collaboration with the Plan President, AVP of Quality & Risk Adjustment, and Network team.

+ Leads team of Practice Transformation resources.

+ Collaborates with Health Plan Network to drive value-based care strategy related to risk adjustment & quality.

+ Sets Health Plan level performance goals and manages progress for key performance indicators.

+ Ensures each Tier 1 and Tier 2 provider have quality & risk adjustment performance goals and execution plans to meet committed goals.

+ Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.

+ Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.

+ Tracks all engagement and training activities using standard Molina Practice Transformation tools to measure effectiveness both within and across Molina Health Plans.

+ Drives provider participation in Molina risk adjustment and quality efforts (e.g., Supplemental data, EMR connection, Clinical Profiles programs) and use of the Provider Collaboration Portal). use of the Molina Provider Collaboration Portal.

+ Is a Practice Transformation subject matter expert; works collaboratively within the Health Plan and across Molina’s Centers of Excellence and Shared Services to drive improved risk adjustment and quality of care.

+ Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.

+ Assesses Provider Engagement team members across required competency matrix and ensures they receive needed training on any lagging competencies.

+ Ensures Practice Transformation team uses standard Molina Practice Transformation reports and training materials.

+ 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 regional market environments and with external provider partners.

+ Maintains the highest level of compliance.

+ This position may require the same day out of office travel approximately 30% of the time, depending upon location.

JOB QUALIFICATIONS

REQUIRED QUALIFICATIONS:

+ Bachelor’s degree in business, Healthcare, Nursing or related field or equivalent combination of education and relevant experience

+ Min 5-7 years’ experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience

+ Experience with various managed healthcare provider compensation methodologies including but not limited to: fee-for service, value-based care, and capitation

+ Strong working knowledge of Quality metrics and risk adjustment practices across all business lines

+ Demonstrates data analytic skills

+ Operational knowledge and experience with PowerPoint, Excel, Visio

+ Effective communication skills

+ Strong leadership skills

PREFERRED QUALIFICATIONS:

+ Master’s Degree

+ Min 5 years’ experience improving provider Quality performance through provider engagement or practice transformation for Medicaid, Medicare, and/or ACA Marketplace programs

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: $84,067 - $163,931 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.