Senior Specialist, Health Plan Member & Community Interventions (Remote)

Molina Healthcare•Long Beach, CA

3d•Remote

About The Position

Provides senior-level support for clinical quality member intervention activities across all lines of business, including Medicare, Marketplace, and Medicaid. Develops and implements new and existing member intervention initiatives, and executes health plan member and community quality-focused interventions and programs in accordance with established program standards and applicable federal, state, and NCQA regulations. Collects data, monitors intervention activities and key performance measures, reports outcomes, and supports continuous improvement of intervention processes and results. The role may require same-day out-of-office travel 0–80% of the time and occasional multi-day overnight travel, depending on state-specific needs.

Requirements

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 an equivalent combination of relevant education and experience.
Demonstrated solid business writing experience.
Proficiency in 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.
Proficiency with Microsoft Office and applicable software programs, and ability to learn new information systems and software programs.

Nice To Haves

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, the license must be active and unrestricted in the state of practice.

Responsibilities

Implement evidence-based and data-informed member intervention strategies, including initiating and managing member and community interventions to remove barriers to care and support federal and state quality initiatives.
Monitor key member intervention activities to ensure timely and accurate completion, and present results to departmental management and other applicable departments.
Write narrative reports interpreting regulatory specifications, explaining programs and results, and documenting intervention findings and limitations.
Create, manage, and compile documentation needed to maintain program milestones, deadlines, and deliverables.
Participate in quality improvement activities, meetings, and discussions with other departments.
Facilitate and build strategic relationships with community-based organizations to support high-quality clinical care and services.
Evaluate quality project and program activities and results to identify opportunities for improvement.
Raise process gaps that may require remediation to quality leadership.
Provide support for quality-related projects.
Train and support new and existing quality member interventions team members.
Adapt to change management with flexibility and a positive outlook.