Health Plan Provider Engagement Manager

Quick Facts

• Role: Health Plan Provider Engagement Manager

• Focus: Provider engagement strategies to improve quality and risk adjustment outcomes

• Areas: Medicaid, Medicare, Marketplace

Description

Provides subject matter expertise and leadership for health plan provider engagement strategies and activities to drive quality and risk adjustment outcomes. Uses a consultative approach to drive physician engagement and behavior change through actionable data and analytics, including value-based care, risk adjustment, and quality improvement activities. Develops, implements, and tracks engagement plans for the largest and most impactful providers with complex value-based contracts.

Responsibilities

• Support provider engagement activities that enhance value-based strategies and risk adjustment/quality improvement initiatives

• Ensure Tier 1 providers have engagement plans meeting annual quality and risk adjustment goals; engage Tier 2 providers as needed

• Coach and collaborate with provider partners through regular meetings and action items to improve quality performance and risk adjustment accuracy

• Coordinate member-facing gap-closing efforts with internal engagement resources to address schedule and open gaps

• Identify and address practice environment barriers to achieve program goals and improve health outcomes

• Drive provider participation in risk adjustment and quality efforts (supplemental data, EMR connections, clinical profiles programs) using a provider collaboration portal

• Mentor Provider Engagement Specialists and Senior Specialists, including training and problem escalation

• Track engagement and training activities using standard provider engagement tools

• Use standard provider engagement reports and training materials; develop and implement related processes and procedures per policies

• Communicate effectively with internal and external stakeholders across provider practices

• Provide training and support for practice transformation and provider engagement teams

• Maintain compliance

Benefits

• Competitive benefits and compensation package

• Pay range: $63,133–$115,000 annually (actual compensation may vary by location, experience, education, and skill level)

Requirements

• At least 6 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 provider compensation methodologies (FFS, value-based care, capitation)

• Strong working knowledge of quality metrics and risk adjustment practices across business lines

• Advanced knowledge of HEDIS/NCQA and/or CMS STARS quality measures and risk adjustment practices across Medicaid, Medicare, and Marketplace

• Strong proficiency in data analysis, manipulation, interpretation, and reporting

• Critical thinking, problem-solving, analytical, 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 cross-functional relationships in a matrixed organization to obtain buy-in and drive results

• Project management experience

• Strong verbal and written communication skills

• Microsoft Office suite (including Excel), Power BI, and other relevant software proficiency; ability to learn new information systems

• Maintain the highest level of compliance

• May require up to 80% same-day out-of-office travel depending on state/health plan requirements