Senior Health Plan Interventions & Community Quality Lead

Molina Healthcare; New Mexico; On-site; USD 70,000 - 90,000; Full time

Job summary

Molina Healthcare provides senior level support for clinical quality member intervention activities across lines of business (Medicare, Marketplace, Medicaid, etc.). It develops and implements new and existing member intervention initiatives, including data collection and monitoring of performance indicators.

The role writes narrative reports, maintains documentation for program milestones, participates in quality improvement activities, and builds relationships with community-based

Qualifications

• At least 3 years of experience in health care and at least 2 years of health plan quality member interventions in a managed care setting.
• Demonstrated solid business writing experience.
• 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 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.

Responsibilities

• Implements evidence-based and data-informed key member intervention strategies including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
• Monitors and ensures that key member intervention activities are completed on time and accurately, and presents results to key departmental management and other applicable Molina departments.
• Writes narrative reports to interpret regulatory specifications, explains programs and results of programs, and documents findings and limitations of department interventions.
• Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
• Participates in quality improvement (QI) 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 (CBOs).
• Evaluates quality project/program activities and results to identify opportunities for improvement.
• Raises gaps in processes that may require remediation to quality leadership.
• Provides support for quality-related projects.
• Provides training and support to new and existing quality member interventions team members.
• Demonstrates flexibility when it comes to change management and maintains a positive outlook.
• This position may require same day out of office travel 0 - 80% of the time, depending upon state-specific needs.
• This position may require multi-day overnight travel on occasion, depending upon state-specific needs.

Skills

Health care experience

Data analysis

HEDIS knowledge

NCQA knowledge

Business writing

Communication

MS Office

Independent work

Job description

Molina Healthcare provides senior level support for clinical quality member intervention activities across lines of business (Medicare, Marketplace, Medicaid, etc.). It develops and implements new and existing member intervention initiatives, including data collection and monitoring of performance indicators.

The role writes narrative reports, maintains documentation for program milestones, participates in quality improvement activities, and builds relationships with community-based