Program Manager, Provider Engagement (Remote in MS only)

$59,811 - $129,590/Yr

Molina Healthcare - Southaven, MS

Full-time - Mid Level

Remote - Southaven, MS

Insurance Carriers and Related Activities

About the position

The Program Manager, Provider Engagement is a key role within Molina Healthcare's Risk Adjustment department, focusing on the development and implementation of strategies and operations related to provider engagement activities. This position aims to enhance risk score accuracy and compliance in government lines of business, ultimately supporting population health management and achieving medical loss ratio targets. The role involves collaboration with various stakeholders, including regulatory agencies, provider networks, and external vendors, to ensure effective program execution and adherence to compliance standards.

Responsibilities

• Collaborates with colleagues to implement and manage provider engagement program initiatives such as provider education/engagement and provider incentives.
• Works with contracted vendors to develop and implement provider education/engagement in risk adjustment models.
• Tracks and monitors success of provider engagement program initiatives against set goals and develops corrective action plans as needed.
• Communicates provider engagement activities to key stakeholders such as provider network teams and health plan teams.
• Develops and maintains program work plans, workflows, and related program documentation.
• Maintains compliance with all policies and procedures, including confidentiality and HIPAA requirements.

Requirements

• Minimum Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience.
• 3-5 years managed care experience, preferably with a national or multi-location organization.
• Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliance.
• Proven ability to innovate and drive organizational change.
• Excellent presentation and communication skills.

Nice-to-haves

• Graduate Degree preferred.

Benefits

• Competitive benefits and compensation package.