Specialist, Health Plan Member & Community Interventions (Remote)

Molina Healthcare; Iowa; Remote; USD 47,000 - 92,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a skilled professional to support clinical quality member intervention activities across Medicare, Marketplace, Medicaid, and other lines of business. You will develop and implement interventions, monitor outcomes, and report results to leadership, ensuring regulatory compliance and continuous improvement.

Role involves building relationships with community organizations and evaluating interventions for effectiveness.

Qualifications

• At least 2 years in health care with 1+ year in health plan quality interventions.
• Solid business writing experience.
• Proficiency in data analysis, manipulation, and interpretation.
• Basic knowledge of HEDIS and NCQA.
• Strong analytical and problem-solving skills.
• Detail-oriented with strong organizational skills.
• Able to adapt to change and work independently in a fast-paced environment.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office and related software.

Responsibilities

• Implement evidence-based and data-informed member intervention strategies.
• Monitor timely completion of interventions and present results to management.
• Write narrative reports interpreting regulatory specifications and program results.
• Create and manage documentation for program milestones and deliverables.
• Participate in quality improvement activities and cross-department discussions.
• Support quality of care by building relationships with community organizations.
• Evaluate project activities and identify opportunities for improvement.
• Flag process gaps to quality leadership.
• Travel up to 80% locally or state-specific requirements; multi-day trips may occur.

Skills

Business writing

Data analysis

Critical thinking

Attention to detail

Communication

Office software

Adaptability

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Provides support 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

• 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 project/program activities and results to identify opportunities for improvement.
• Raises gaps in processes that may require remediation to quality leadership.
• 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.

Required Qualifications

• At least 2 years of experience in health care, and at least 1 year of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
• Demonstrated solid business writing experience.
• Proficiency with 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.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• 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, 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: $47,433 - $92,494 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.