Specialist, Member & Community Interventions (Remote in MA)

Molina Healthcare; City of Syracuse (NY); Remote; USD 64,000 - 117,000; Full time

Job summary

A healthcare organization is seeking a Specialist in Member & Community Interventions. The role focuses on implementing and monitoring clinical quality member intervention initiatives across various lines of business, supporting healthcare quality programs through data collection and reporting. Candidates should have an Associate’s degree and relevant healthcare experience. The pay range is competitive, varying based on experience and location.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

• 1-3 years’ experience in healthcare, ideally in health plan quality interventions.
• Demonstrated solid business writing experience.

Responsibilities

• Implement key member intervention strategies.
• Monitor and ensure timely completion of intervention activities.
• Support quality improvement activities.

Skills

Problem-solving skills

Business writing

Operational knowledge of Excel

Operational knowledge of Visio

Education

Associate’s degree or equivalent

Bachelor’s Degree in Nursing or related field

Job description

Job Description

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)
• Meeting coordination and direction
• Experience working with special needs population.

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

Pay Range: $64,350 - $116,835 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.