Senior Specialist, Member & Community Interventions (Remote in Pacific Time)

Molina Healthcare•Las Vegas, NV

28d•Remote

About The Position

The Sr Specialist, Member & Community Interventions oversees and 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. Acts as a lead specialist within the department and/or collaboratively with other departments.

Requirements

Bachelor's Degree or equivalent combination of education and work experience.
3 years' experience in healthcare with a minimum of 2 years' experience in health plan member interventions, managed care, or equivalent experience.
Demonstrated solid business writing experience.
Operational knowledge and experience with Excel and Visio (flow chart equivalent)
Demonstrates flexibility when it comes to changes and maintains a positive outlook.
Has excellent problem-solving skills.

Nice To Haves

1 year of experience in Medicare and in Medicaid managed care
Experience with data reporting, analysis, and/or interpretation
Certified Professional in Health Quality (CPHQ)
Nursing License (RN may be preferred for specific roles)
Certified HEDIS Compliance Auditor (CHCA)
Basic SQL experience

Responsibilities

Acts as a lead specialist to provide project, program, and/or initiative related direction and guidance for other specialists within the department and/or collaboratively with other departments
Implements evidence-based and data-informed 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
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