Job Details

Job Summary

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, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Job Duties

Implements evidence-based and data-informed key member intervention strategies, which may include initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state-required quality activities

Monitors and ensures that key member intervention activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed

Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions

Creates, manages, and/or compiles the required documentation to maintain critical program milestones, deadlines, and/or deliverables

Participates in quality improvement 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

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 when it comes to changes 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, depending upon location

This position may require multiple days out-of-town overnight travel on occasion, depending upon location

Job Qualifications

Required 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

Preferred Qualifications:

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)

Certified Community Health Worker (CCHW)

Bi-Lingual preferred.

Molina Healthcare offers a competitive benefits and compensation package

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

#PJCorp #LI-AC1

Pay Range: $47,433 - $92,494 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.