Specialist, Health Plan Member & Community Interventions (Remote)

Molina Healthcare•Long Beach, CA

3d•Remote

About The Position

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

Requirements

At least 2 years of health care experience and at least 1 year of health plan quality member intervention experience 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.
Basic 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 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/or community interventions to remove barriers to care and support federal and state quality initiatives.
Monitor and ensure key member intervention activities are completed accurately and on time, and present results to departmental management and other applicable departments.
Write narrative reports interpreting regulatory specifications, explaining programs and their 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.
Support high-quality clinical care and services by facilitating and building strategic relationships with community-based organizations.
Evaluate project and program activities and results to identify improvement opportunities.
Raise process gaps that may require remediation to quality leadership.
Conduct same-day out-of-office travel, potentially 0–80% of the time, depending on state-specific needs, and occasional multi-day overnight travel.