Specialist, Member & Community Interventions - Quality / HEDIS (Remote in OH)

Molina Healthcare; Kentucky; Remote; USD 49,000 - 98,000; Full time

Job summary

A leading healthcare organization is seeking a Specialist, Member & Community Interventions to implement clinical quality member initiatives. The role requires an Associate’s degree, with 1-3 years in healthcare and emphasizes solid business writing and problem-solving skills. The position offers a competitive salary range of $49,930 - $97,363 annually based on experience, with opportunities for continuous improvement in member interventions.

Benefits

Competitive benefits and compensation package

Qualifications

• 1-3 years’ experience in healthcare with 1-year experience in health plan quality member interventions.
• Excellent problem-solving skills required.
• Demonstrated solid business writing experience.

Responsibilities

• Implement key member intervention strategies and manage community interventions.
• Monitor and ensure timely completion of intervention activities.
• Write narrative reports on regulatory specifications and program results.

Skills

Business writing

Problem-solving

Operational knowledge of Excel

Operational knowledge of Visio

Education

Associate’s degree or equivalent

Bachelor’s Degree in Nursing, Social Work, Clinical Quality, Public Health, or Healthcare Administration

Job description

Job Description

The Specialist, Member & Community Interventions implements new and existing clinical quality member intervention initiatives including 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, conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Job Summary

The Specialist, Member & Community Interventions implements new and existing clinical quality member intervention initiatives including 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, conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Job Duties

• Implements evidence-based and data-informed key 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 to present 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/or deliverables
• Participates in quality improvement 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
• 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
• Demonstrates flexibility when it comes to changes and maintains a positive outlook
• Other tasks, duties, projects, and programs as assigned
• This position may require same-day out-of-office travel 0 - 80% of the time, depending upon location
• This position may require multiple days out-of-town overnight travel on occasion, depending upon location

Job Qualifications

REQUIRED QUALIFICATIONS:

• Associate’s degree or equivalent combination of education and work experience
• 1-3 years’ experience in healthcare with 1-year experience in health plan quality member interventions, managed care, or equivalent experience
• Demonstrated solid business writing experience
• Operational knowledge and experience with Excel and Visio (flow chart equivalent)
• Excellent problem-solving skills

PREFERRED QUALIFICATIONS:

• Bachelor’s Degree in preferred field: Nursing, Social Work, Clinical Quality, Public Health, or Healthcare Administration
• 1 year of experience in Medicare and in Medicaid managed care
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• Certified HEDIS Compliance Auditor (CHCA)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing

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

Pay Range: $49,930 - $97,363 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.