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

Molina Healthcare; Ohio; On-site; USD 49,930 - 97,363; Full time

Job summary

A national healthcare provider is seeking a Specialist in Member & Community Interventions to implement intervention strategies and ensure high-quality clinical care. Ideal applicants have a healthcare background with experience in member interventions, excellent writing and problem-solving skills. The role offers competitive compensation and requires some travel flexibility.

Qualifications

• 1-3 years’ experience in healthcare with 1-year experience in member interventions or managed care.
• Demonstrated solid business writing experience.
• Excellent problem-solving skills.

Responsibilities

• Implement member intervention strategies to remove barriers to care.
• Ensure completion of member intervention activities on time.
• Write reports to interpret and document findings.

Skills

Business writing

Problem-solving

Operational knowledge of Excel

Operational knowledge of Visio

Education

Associate’s degree or equivalent

Bachelor’s Degree in relevant field

Tools

Excel

Visio

Job description

Overview

Specialist, Member & Community Interventions (Remote in OH)

Responsibilities

• 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

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)

Additional Information

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.