Specialist, Critical Incidents (Must reside in NM)

Molina Healthcare•Long Beach, NM

About The Position

Job SummaryProvides support for critical incident management activities, including provision of critical incident management referral support to members. Strives to ensure member progress toward desired outcomes in conjunction with interdisciplinary team facilitating integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties Reviews, monitors and provides recommendations for next steps related to member critical incidents. Monitors compliance with critical incident related best practices and quality standards. Completes notifications for immediately reportable incidents to applicable regulating bodies in compliance with contract requirements, and provides regular updates to and serves as primary contact to designated regulator(s) related to incident resolution. Completes member chart reviews for member health and safety concerns and associated interventions; compiles and provides findings to appropriate entities as indicated; and provides timely notification to leadership when additional review is needed. Provides mentoring and consultation staff as related to member health and safety; provides monitoring and oversight of member releases from correctional facilities and treatment centers; and provides consultation on member specific cases related to risk assessment and mitigation. Assists with the development and maintenance of resources in the area of member health and safety to include domestic violence, law enforcement involvement, abuse, neglect and self-neglect. Attends workgroups and meetings with external organization representatives, and maintains a continuing working relationship with external organizations and their representatives. Attends regular team meetings and collaborates with peers and other departments on incident/risk mitigation/health and safety projects and initiatives. Assists in developing policies and procedures to integrate best practices and inform staff of expected standards of practice as it relates to the incident management system, member health and safety, and risk mitigation. Monitors assigned compliance with best practice standards. Requires travel 10%-20% of the time for meetings if needed.

Requirements

At least 2 years of experience in health care, preferably in a capacity supporting critical health incidents, member health and safety, or risk mitigation, or equivalent combination of relevant education and experience.
Some states may required a bachelor’s degree in a health-related field, or associate degree in nursing (depends on state/contractual requirements).
Detail and solution-oriented.
Ability to work in a fast-faced environment.
Ability to prioritize critical incidents and manage daily deadlines.
Strong organizational and follow-up skills.
Strong written and verbal communication skills.

Nice To Haves

Previous critical incident, member health and safety, and or risk mitigation experience.
Previous long-term care experience.
Previous experience working with persons with disabilities and the frail elderly.
Previous Electronic Medical Record (EMR) experience, and understanding of Health Insurance Portability and Accountability Act (HIPAA).

Responsibilities

Reviews, monitors and provides recommendations for next steps related to member critical incidents.
Monitors compliance with critical incident related best practices and quality standards.
Completes notifications for immediately reportable incidents to applicable regulating bodies in compliance with contract requirements, and provides regular updates to and serves as primary contact to designated regulator(s) related to incident resolution.
Completes member chart reviews for member health and safety concerns and associated interventions; compiles and provides findings to appropriate entities as indicated; and provides timely notification to leadership when additional review is needed.
Provides mentoring and consultation staff as related to member health and safety; provides monitoring and oversight of member releases from correctional facilities and treatment centers; and provides consultation on member specific cases related to risk assessment and mitigation.
Assists with the development and maintenance of resources in the area of member health and safety to include domestic violence, law enforcement involvement, abuse, neglect and self-neglect.
Attends workgroups and meetings with external organization representatives, and maintains a continuing working relationship with external organizations and their representatives.
Attends regular team meetings and collaborates with peers and other departments on incident/risk mitigation/health and safety projects and initiatives.
Assists in developing policies and procedures to integrate best practices and inform staff of expected standards of practice as it relates to the incident management system, member health and safety, and risk mitigation.
Monitors assigned compliance with best practice standards.