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Dir, Provider Engagement (Quality, Value-Based Strategic Leader) - MI Health Plan

Company: Molina Healthcare
Location: Troy
Posted on: August 4, 2022

Job Description:

JOB DESCRIPTION Job Summary Develops and implements the quality and value-based contracting strategy to achieve positive quality, operational and financial outcomes. This role will be primarily remote but there may be expectations to work in Molina s Troy, MI office once a week or as needed. KNOWLEDGE/SKILLS/ABILITIES

  • Leads strategic plan for provider pay-for-performance, value-based contracting and quality improvement programs to improve Quality outcomes and MCR.
  • Establishes the strategy and operational direction for all Provider Engagement Team (PET) activity, in collaboration with leadership and VP of Network Contracting.
  • Monitors and develops pay for performance and value-based provider programs.
  • Leads the analyzation and reporting on on Strategic Provider results (e.g. changes in Quality outcomes, MCR, financial results, etc.) to Senior Leadership Team.
  • Ensures health plan PET stakeholders are engaged to improve quality through strategic goals, reported to health plan Senior Leadership Team meetings.
  • May lead one or more cross-departmental teams from (Quality, Provider Services, Clinical, Operations) to engage with key providers.
  • Participates in MDHHS or CMS statewide initiatives for quality improvement
  • Builds internal relationships to develop a TEAM approach to Provider Engagement.
  • Builds and nurture positive relationships between strategic providers and Plan. JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent provider contract network development & management, and project management experience, in a managed healthcare setting. Required Experience
    • Min 7 years experience in managed healthcare administration, Provider Quality and/or Provider Contracting.
    • Min 7 years experience in provider contract negotiations in a managed healthcare setting.
    • Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: fee-for service, capitation, value based agreements, pay for performance and various forms of risk, PHO/PO relationships, etc. Preferred Education Master's Degree Preferred Experience
      • Experience managing a PHO/PO and/or negotiating different provider contract types, i.e. physician, group and hospital contracting, etc.
      • Experienced in strategy development with a focus on quality improvement and outcomes. 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.

Keywords: Molina Healthcare, Troy , Dir, Provider Engagement (Quality, Value-Based Strategic Leader) - MI Health Plan, Healthcare , Troy, Michigan

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