Manager, Health Plan Member & Community Interventions

Molina Healthcare; Jackson (MS); On-site; USD 65,792 - 142,548; Full time

Benefits offered by this job

Competitive benefits

EOE:M/F/D/V

Job summary

Molina Healthcare in Mississippi seeks a senior quality interventions leader to manage a team focused on clinical quality and member interventions. You will develop state-based programs, coordinate with CBOs, and track performance measures to improve patient outcomes across Medicare, Medicaid, and Marketplace plans.

The role requires 7+ years in health care and 4+ years in quality interventions with leadership experience; NCQA/HEDIS knowledge is essential.

Qualifications

• At least 7 years in health care with 4+ years in health plan quality interventions.
• Minimum 1 year of management/leadership experience.
• Ability to lead cross-functional teams implementing quality interventions.
• Proficient in data analysis and interpretation; NCQA/HEDIS knowledge.
• Strong detail orientation and organizational skills; able to work in a matrixed org.

Responsibilities

• Lead the team delivering clinical quality intervention activities across lines of business.
• Develop and implement state-based quality interventions meeting regulatory standards.
• Manage portfolio of member and community quality initiatives to improve outcomes.
• Collaborate with community-based organizations to boost clinical quality results.
• Track quality measures, report outcomes, and drive continuous improvement.
• Coordinate meetings, prepare materials, and monitor action items to completion.
• Maintain documentation and SharePoint content for health plan interventions.
• Travel 30–40% within Mississippi as needed.

Skills

Cross-functional leadership

Data analysis

HEDIS/NCQA knowledge

Project management

Communication skills

Independent work

Microsoft Office

Education

RN license (active in state)

CPHQ Certification

CHCA Certification

Tools

None

Job description

JOB DESCRIPTION

Employee for this role must reside in Mississippi

Job Summary

Leads and manages team responsible for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid, etc.). Executes health plan member and community quality-focused interventions and programs in accordance with established program standards, and federal/state/National Committee for Quality Assurance (NCQA) regulations. Conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Essential Job Duties

• Develops and implements evidence-based and data informed state-based quality interventions that meet state and federal regulatory requirements.
• Manages a robust and strategic portfolio of member and community quality focused interventions to achieve positive operational and financial outcomes.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs) to drive improved clinical quality health outcomes.
• Develops, tracks, and reports quality key quality performance measures.
• Facilitates and actively participates in quality program discussions and activities with internal and external stakeholders.
• Oversees, develops and coordinates quality-related initiatives with internal stakeholders, includes support for meeting agendas, minutes, and materials; monitors action items to completion, and ensures stakeholders are engaged and prepared to report updates at regularly scheduled meetings.
• Maintains the completeness and accuracy of the member interventions SharePoint site.
• Creates and maintains documentation related to health plan interventions.
• Ensures all documents are appropriately approved by Molina and/or state regulatory agencies as required by policy.
• Leads or participates in quality improvement activities, meetings, and discussions with other departments.
• Collaborates across health plan teams to improve member clinical quality outcomes (e.g., healthcare services, growth and community engagement, network, etc.).
• Hires, trains, mentors, develops, and performance manages quality team; demonstrates accountability for team performance/goal achievement.
• This position may require same day out of office travel 30-40% within Mississippi.
• This position may require multi-day overnight travel on occasion, depending upon state-specific needs.

Required Qualifications

• At least 7 years of experience in health care, and at least 4 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
• At least 1 year management/leadership experience.
• Ability to lead and influence cross-functional teams that oversee implementation of quality interventions.
• Proficiency with 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 work cross-collaboratively in a highly matrixed organization.
• 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.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Experience with member/provider (Healthcare Effectiveness Data and Information Set (HEDIS)) outreach and/or quality interventions or improvement studies (development, implementation, evaluation).
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
• Certified Professional in Health Quality (CPHQ)
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.

Molina Healthcare offers a competitive benefits and compensation package.

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

Pay Range: $65,792 - $142,548 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.