1351 Virtual Case Manager jobs in Albuquerque,NM

Senior Specialist, Health Plan Provider Engagement (Remote in NM)

Molina Healthcare

Albuquerque, NM 87103

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.