Role Description

The Sr Specialist, Member & Community Interventions oversees and implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid). Executes health plan’s member and community quality focused interventions and programs in accordance with prescribed program standards, conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes. Acts as a lead specialist within the department and/or collaboratively with other departments.

Please make sure to update your resume with any previous HEDIS/Quality experience. We look forward to reviewing!

Qualifications

• Bachelor's Degree or equivalent combination of education and work experience.
• 3 years’ experience in healthcare with a minimum of 2 years’ experience in health plan member interventions, managed care, or equivalent experience.
• Demonstrated solid business writing experience.
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).
• Demonstrates flexibility when it comes to changes and maintains a positive outlook.
• Has excellent problem-solving skills.

Requirements

• 1 year of experience in Medicare and in Medicaid managed care (preferred).
• Experience with data reporting, analysis, and/or interpretation (preferred).
• Certified Professional in Health Quality (CPHQ) (preferred).
• Nursing License (RN may be preferred for specific roles) (preferred).
• Certified HEDIS Compliance Auditor (CHCA) (preferred).

Benefits

• Molina Healthcare offers a competitive benefits and compensation package.