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Role Description

The Specialist, Member & Community Interventions 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 and monitors intervention activity including key performance measurement activities
• Reports intervention outcomes and supports continuous improvement of intervention processes and outcomes
• Implements evidence-based and data-informed key member intervention strategies
• Monitors and ensures that key member intervention activities are completed on time and accurately
• Writes narrative reports to interpret regulatory specifications and document findings
• Creates, manages, and/or compiles the required documentation to maintain critical program milestones
• Participates in quality improvement activities and discussions with other departments
• Supports provision of high-quality clinical care and services by facilitating relationships with community-based organizations
• Evaluates project/program activities and results to identify opportunities for improvement
• Surfaces to the Manager and Director any gaps in processes that may require remediation
• Demonstrates flexibility and maintains a positive outlook
• Other tasks, duties, projects, and programs as assigned
• This position may require same-day out-of-office travel 0 - 80% of the time
• This position may require multiple days out-of-town overnight travel on occasion

Qualifications

• Associate’s degree or equivalent combination of education and work experience
• 1-3 years’ experience in healthcare with 1-year experience in health plan quality member interventions, managed care, or equivalent experience
• Demonstrated solid business writing experience
• Operational knowledge and experience with Excel and Visio (flow chart equivalent)
• Excellent problem-solving skills

Requirements

• Bachelor’s Degree in preferred field: Nursing, Social Work, Clinical Quality, Public Health, or Healthcare Administration
• 1 year of experience in Medicare and in Medicaid managed care
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• Certified HEDIS Compliance Auditor (CHCA)

Benefits

• Molina Healthcare offers a competitive benefits and compensation package