Senior Specialist, Member & Community Interventions (Remote in TX)

Molina Healthcare; Texas; Remote; USD 54.922 - 107.099; Vollzeit

Benefits dieser Stelle

Competitive salary

Comprehensive benefits package

Zusammenfassung

A healthcare services provider is seeking a Senior Specialist in Member & Community Interventions to oversee and implement clinical quality initiatives across various healthcare programs. Responsibilities include providing direction to specialists, implementing data-informed strategies, and evaluating project outcomes. The ideal candidate will have a Bachelor's Degree, with at least 3 years of relevant healthcare experience, and strong business writing and problem-solving skills. This remote position offers a competitive salary and benefits package.

Qualifikationen

• 3 years' experience in healthcare with minimum 2 years in health plan member interventions.
• Operational knowledge with Excel and Visio (flow chart equivalent).
• Experience in Medicare and Medicaid managed care preferred.

Aufgaben

• Oversees and implements clinical quality member intervention initiatives.
• Monitors key member intervention activities and presents results.
• Evaluates project/program activities for improvement opportunities.

Kenntnisse

Business writing experience

Problem-solving skills

Flexibility and positive outlook

Ausbildung

Bachelor’s Degree or equivalent

Tools

Excel

Visio

Jobbeschreibung

Senior Specialist, Member & Community Interventions (Remote in TX)

Apply for the Senior Specialist, Member & Community Interventions (Remote in TX) role at Molina Healthcare.

Job Summary

The Sr Specialist, Member & Community Interventions oversees and implements new and existing clinical quality member intervention initiatives across all lines of business (Medicare, Marketplace, Medicaid). Executes health plan’s member and community quality focused interventions and programs in accordance with prescribed program standards, collects data, monitors intervention activity and key performance measurements, reports outcomes, and supports continuous improvement of intervention processes and outcomes. Acts as a lead specialist within the department and/or collaborates with other departments.

Job Duties

• Acts as a lead specialist to provide project, program, and/or initiative related direction and guidance for other specialists within the department and/or collaboratively with other departments.
• Implements evidence-based and data-informed member intervention strategies, which may include initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state-required quality activities.
• Monitors and ensures that key member intervention activities are completed on time and accurately, presenting results to key departmental management and other Molina departments as needed.
• Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.
• Creates, manages, and/or compiles the required documentation to maintain critical program milestones, deadlines, and deliverables.
• Participates in quality improvement activities, meetings, and discussions with and between other departments.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations.
• Evaluates project/program activities and results to identify opportunities for improvement.
• Surfaces to the Manager and Director any gaps in processes that may require remediation.
• Other tasks, duties, projects, and programs as assigned.
• May require same-day out-of-office travel 0–30% of the time, depending on location.
• May require multiple days out-of-town overnight travel on occasion, depending on location.

Qualifications

Required

• Bachelor’s Degree or equivalent combination of education and work experience.
• 3 years’ experience in healthcare with a minimum of 2 years’ experience in health plan member interventions, managed care, or equivalent experience.
• Demonstrated solid business writing experience.Operational knowledge and experience with Excel and Visio (flow chart equivalent).
• Demonstrates flexibility regarding changes and maintains a positive outlook.
• Excellent problem-solving skills.

Preferred

• 1 year of experience in Medicare and in Medicaid managed care.
• Experience with data reporting, analysis, and/or interpretation.
• Certified Professional in Health Quality (CPHQ).
• Nursing License (RN may be preferred for specific roles).
• Certified HEDIS Compliance Auditor (CHCA).

Benefits & Compensation

Pay Range: $54,922 – $107,099 annual (actual compensation may vary based on geographic location, work experience, education, and/or skill level).

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.