Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Specialist, Health Plan Provider Engagement
Location
United States
Posted
11 days ago
Salary
$45.4K - $88.5K / year
Seniority
Mid Level
Job Description
Specialist, Health Plan Provider Engagement
Molina Healthcare
Role Description Provides support for health plan provider engagement activities. Drives value-based care strategies through risk adjustment and quality improvement activities. Ensures smaller, less advanced tier II and tier III providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives. Qualifications - At least 2 years of experience improving provider quality performance through provider engagement, practice transformation, and/or managed care quality improvement initiatives, or equivalent combination of relevant education and experience. - Experience with various managed health care provider compensation methodologies including but not limited to: fee-for service (FFS), value-based care (VBC), and capitation. - Working knowledge of quality metrics and risk adjustment practices across all business lines. - Knowledge and understanding of HEDIS/NCQA. - Proficiency with data analysis, manipulation, interpretation and reporting. - Critical-thinking, problem-solving and analytical skills. - Relationship building skills. - Attention to detail and organizational skills. - Ability to implement process improvement initiatives and drive change. - Ability to work independently in a fast-paced, deadline-driven environment. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs. Requirements - Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives. - Ensures assigned tier II and tier III providers have a provider engagement plan to meet annual quality and risk adjustment performance 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. - Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal. - Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness. - Works collaboratively with health plan and shared service partners to ensure alignment to business goals. - Accountable for use of standard Molina Provider Engagement reports and training materials. - 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 health plan and corporate policies. - Communicates effectively with internal and external stakeholders, including providers, practice managers, and medical assistants within assigned provider practices. - Maintains the highest level of compliance. - May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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Senior Specialist, Health Plan Provider Engagement
Molina HealthcareMolina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Role Description Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach emphasizing physician engagement and behavior change through actionable data and analytics. Drives value-based care strategies through risk adjustment and quality improvement activities. Ensures assigned Tier 1 & Tier 2 providers have engagement plans ensuring they meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives. Qualifications - At least 3 years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement, or equivalent combination of relevant education and experience. - Experience with various managed health care provider compensation methodologies including but not limited to: fee-for-service (FFS), value-based care (VBC), and capitation. - Working knowledge of quality metrics and risk adjustment practices across all business lines. - Knowledge and understanding of HEDIS/NCQA and/or CMS STARs quality measures and risk adjustment practices across Medicaid, Medicare and Marketplace. - Proficiency with data analysis, manipulation, interpretation and reporting. - Critical-thinking, problem-solving and analytical skills. - Relationship building skills. - Attention to detail and organizational skills. - Ability to implement process improvement initiatives and drive change. - Ability to work independently in a fast-paced, deadline-driven environment. - Ability to foster and build relationships in a cross-functional highly matrixed organization to obtain buy-in and drive results. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), Power BI, and other applicable software programs proficiency, and ability to learn new information systems and software programs. Requirements - Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives. - Ensures assigned Tier 1, Tier 2, and where applicable Tier 3, providers have a provider engagement plan to meet annual quality and risk adjustment performance goals. - Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution. - Works with provider front-office staff to get the Molina members with the most open gaps on the schedule and seen by their assigned provider. - Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side. - Addressees challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes. - Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal. - Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness both within and across Molina health plans. - Serves as provider engagement subject matter expert; works collaboratively with health plan and shared service partners to ensure alignment to business goals. - Collaborates with assigned health plan Provider Relations Network team member on operational, provider and member issues. - Accountable for use of standard Molina Provider Engagement reports and training materials. - Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies. - Communicates comfortably and effectively with internal and external stakeholders, including physician leaders, providers, practice managers, and medical assistants within assigned provider practices. - Provides training and support for new and existing practice transformation and provider engagement team members. - Maintains the highest level of compliance. - May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Role Description Grasshopper Bank is a client-first, digital bank built for the business and innovation economy, with an obsession for providing leading-edge technology, solutions-driven products and superior service through a combination of passionate people and digital resources. In this role, you will effectively manage a caseload of commercial loans while collaborating closely with the broader operations team to ensure accurate processing, servicing, and reporting functions. Your daily responsibilities will include: - Perform initial setup, data entry, and system record creation for new Commercial Real Estate (CRE), Sponsor Banking, and Yacht loans, including onboarding primary borrowers, guarantors, and associated Demand Deposit Accounts (DDAs). - Manage the ongoing lifecycle of existing loans by processing renewals, amendments, extensions, and term modifications. - Process daily loan advances, payments, insurance updates, and manage unused fee calculations and billing on undrawn lines of credit. - Process participation payments, notices, and wires (specifically handling Fieldpoint and BancAlliance programs), as well as general incoming and outgoing wire transfer reviews. - Issue and administer Letters of Credit and generate accurate invoices for loan-related fees and payments. - Perform post-booking general loan quality control to ensure data accuracy and adherence to bank policies. Systematically review FCM, nCino, and FIS reports to identify and correct exceptions, delinquencies, and errors during maintenance cross-checks. - Reconcile and balance various General Ledger (GL) and DDA accounts. Perform core edits and FIS Bank Control adjustments (e.g., updating interest rate indexes). - Manage internal and external inquiries via Zendesk. Research FIS system issues and open Client Portal tickets to resolve core banking platform problems. - Gather documentation to respond to internal/external audit inquiries and actively document, refine, and improve written loan operations procedures. - Handle routine administrative duties, daily reports, and general in-office responsibilities necessary for smooth operations. Qualifications - A minimum of 3-5 years experience in Loan Processing/Servicing at a commercial or community bank. - Proficiency with modern loan documentation and origination software, specifically nCino. - Extensive experience with core banking systems, specifically FIS/IBS and the US Bank letter of credit portal. - Experience using FCM and ticketing/service systems like Zendesk. - In-depth knowledge of loan processes, documentation review, and collateral management. - Strong fluency with loan servicing across different loan types (e.g., CRE, C&I, Sponsor Banking, Yacht). - Deep understanding of Participations (e.g., Fieldpoint, BancAlliance), Letters of Credit, Term loans, and syndicated loans. - Proven experience in General Ledger (GL) and Demand Deposit Account (DDA) reconciliation. - Working knowledge of regulatory requirements within the loan operations department and experience handling audit inquiries. - Advanced knowledge of Microsoft Office (e.g. Word, Excel, PowerPoint) and/or Google Workspace products. - Excellent interpersonal, communication, and procedural writing skills. Requirements - This will be a 3 month contract with potential to extend to 6 months.
Role Description We are looking for a sharp, organized, and business-minded AR & AP Specialist to join our Accounting team. Attention to detail is everything in this role. The ideal candidate brings proven experience in accounts receivable, collections, and accounts payable — ideally within a B2B wholesale or inventory-driven environment — and is ready to bring that same care and precision to a remote setting. This person will report to the Director of Accounting and work closely with internal and external partners across AR, AP, cash management, and compliance functions. If you take quiet pride in accurate, process-driven work and want to plant roots with a team that values stability and excellence, this is your role. Qualifications - 1.5 or more years of AR, Collections, and AP experience — preferably in a B2B wholesale or related inventory environment - Associate degree or equivalent experience in Accounting, Business Accounting, or Finance - Working knowledge of accounting software platforms — Sage Intacct strongly preferred - High proficiency with Google Suite and Microsoft Excel - Personal integrity — ability to keep customer, vendor, and company information strictly confidential - Natural aptitude for accuracy and meticulous detail, with a genuine proficiency or passion for numbers - Ability to work well both independently and as part of a team - Thorough understanding of basic accounting, bookkeeping, and corporate finance principles and procedures — multi-entity experience is a plus - Reliable and available during US business hours with consistent, professional presence in a remote setting Requirements - Prefer structured, repeatable work over constant variety or ambiguity - Take quiet pride in accuracy and process — details matter to you and you hold yourself to a high standard - Work independently without needing frequent check-ins or social energy to stay motivated - Communicate clearly in writing and are comfortable presenting prepared data calmly and confidently to the CEO and other executives - Want to plant roots — this team values stability, and you are not looking for a stepping stone Benefits - This is a full time role - Rate is $6-$7/hr - 100% Remote
Role Description The Construction Monitoring Specialist is responsible for reviewing and managing construction loan activity to ensure projects progress in accordance with approved budgets, timelines, and bank requirements. This role partners closely with Lenders, Credit Officers, and Portfolio Managers to support timely draw processing, maintain compliance, and proactively identify and mitigate risk. - Reviews and processes construction loan draw requests for accuracy, completeness, and compliance with loan terms. - Analyzes project budgets, lien waivers, inspection reports, title updates, and related documentation. - Ensures disbursements align with verified project progress and percentage of completion. - Collaborates with Lenders, Credit Officers, and Portfolio Managers to obtain required information and resolve discrepancies. - Communicates with borrowers, builders, inspectors, and title companies through lending team to support efficient processing. - Reviews third-party inspection reports to confirm work completion. - Makes accurate loan records, including disbursements, communications, and status updates. - Monitors project timelines and supports adherence to approved construction schedules. - Manages multiple loans simultaneously while meeting established turnaround times. - Supports internal audits and ensures compliance with bank policies and regulatory requirements. Qualifications - High school diploma or general education degree (GED), required. - Associate’s degree in Finance, Business, Construction Management, or related field, preferred. - Minimum of 2 years of experience in construction lending, loan operations, banking, or construction project management required. - Knowledge of construction draw processes and documentation preferred. Requirements - Banking is a highly regulated industry; proficiency in the Bank's policies and procedures is expected. - Adhere to all laws, rules, and regulations applicable to your conduct and work. - Complete all assigned compliance training in a timely manner. - Strong analytical, organizational, and problem-solving skills. - Effective written and verbal communication skills in a remote environment. - Ability to work in a fast-paced work environment. - Professional appearance and demeanor. - Ability to research problem situations and recommend appropriate action. - Maintain positive relations with all customers, both internal and external, while discussing legal matters professionally and tactfully. - Must be able to work in a team environment with interaction amongst other members. - Effective organizational skills with attention to detail and promptness. - Experience using Microsoft Products including Word, Excel, and Outlook. - Ability to understand and utilize banking industry technology. - Proficiency in loan processing systems.


