Senior Health Plan Interventions Lead

Molina Healthcare; Meridian (ID); Remote; USD 49,000 - 96,000; Full time

Job summary

Molina Healthcare seeks a senior specialist to lead and support clinical quality member intervention activities across Medicare, Marketplace, and Medicaid. You will develop and implement intervention initiatives, collect data, monitor performance, and communicate results to leadership.

The role emphasizes regulatory compliance (NCQA/HEDIS), collaboration with community organizations, and driving continuous improvement. Travel may be required periodically.

Qualifications

• Minimum 3 years experience in health care and 2 years in health plan quality interventions in managed care or equivalent.
• Demonstrated solid business writing experience.
• Proficiency with data analysis, manipulation and interpretation.
• Knowledge of HEDIS and NCQA requirements.
• Strong critical-thinking, problem-solving and analytical skills.
• Attention to detail and organization.
• Ability to navigate change with flexibility and a positive outlook.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Excellent verbal and written communication skills.
• Proficiency with MS Office and related software; ability to learn new systems.

Responsibilities

• Implements evidence-based and data-informed member intervention strategies across programs.
• Monitors intervention activities for timeliness and accuracy; presents results to management.
• Writes narratives interpreting regulatory specifications and program results.
• Prepares and maintains documentation for program milestones and deliverables.
• Participates in quality improvement activities and cross-department collaboration.
• Supports building relationships with community-based organizations to improve care.
• Evaluates project activities to identify improvement opportunities.
• Raises process gaps to quality leadership and supports related projects.
• Provides training and support to quality interventions team members.
• Adapts to change management while maintaining a positive outlook.
• May require substantial travel (0-80% depending on state needs) and occasional multi-day trips.

Skills

Healthcare experience

Quality improvement

Data analysis

HEDIS/NCQA knowledge

Regulatory reporting

Business writing

Communication skills

Change management

Education

CPHQ certification

CHCA certification

RN license

Tools

Microsoft Office

Microsoft Excel

Job description

Molina Healthcare seeks a senior specialist to lead and support clinical quality member intervention activities across Medicare, Marketplace, and Medicaid. You will develop and implement intervention initiatives, collect data, monitor performance, and communicate results to leadership.

The role emphasizes regulatory compliance (NCQA/HEDIS), collaboration with community organizations, and driving continuous improvement. Travel may be required periodically.