Senior Specialist, Health Plan Member & Community Interventions

Description JOB DESCRIPTION Job Summary - 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. Essential Job Duties - 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. Required Qualifications - 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. Preferred Qualifications - 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