Senior Specialist, Health Plan Member & Community Interventions

Provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid, etc.). Executes health plan member and community quality-focused interventions and programs in accordance with established program standards, and federal/state/National Committee for Quality Assurance (NCQA) regulations. Conducts data collection, 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 including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
  • Monitors and ensures that key member intervention activities are completed on time and accurately, and presents results to key departmental management and other applicable Molina departments.
  • Writes narrative reports to interpret regulatory specifications, explains programs and results of programs, and documents findings and limitations of department interventions.
  • Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
  • Participates in quality improvement (QI) activities, meetings, and discussions with and between other departments within the organization.
  • Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs).
  • Evaluates quality project/program activities and results to identify opportunities for improvement.
  • Raises gaps in processes that may require remediation to quality leadership.
  • Provides support for quality-related projects.
  • Provides training and support to new and existing quality member interventions team members.
  • Demonstrates flexibility when it comes to change management and maintains a positive outlook.
  • This position may require same day out of office travel 0 - 80% of the time, depending upon state-specific needs.
  • This position may require multi-day overnight travel on occasion, depending upon state-specific needs.

• At least 3 years of experience in health care, and at least 2 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
  • Demonstrated solid business writing experience.
  • Proficiency with data analysis, manipulation and interpretation.
  • Intermediate knowledge and understanding of HEDIS and NCQA.
  • Critical-thinking, problem-solving and analytical skills.
  • Attention to detail and organizational skills.
  • Ability to navigate change with flexibility and a positive outlook.
  • Ability to work independently in a fast-paced, deadline-driven environment.
  • Effective verbal and written communication skills.
  • Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

• Experience with data reporting, analysis, and interpretation.
  • Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs.
  • Certified Professional in Health Quality (CPHQ).
  • Certified HEDIS Compliance Auditor (CHCA).
  • Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Originally posted on Himalayas