Senior Specialist, Member & Community Interventions - HEDIS / Stars / Quality Im

Job Description

Job Summary

The Sr Specialist, Member & Community Interventions oversees and 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. Acts as a lead specialist within the department and/or collaboratively with other departments.

Please make sure to update your resume with any previous HEDIS/Quality Improvement and/or Medicare Stars experience. We look forward to reviewing!

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 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
• Other tasks, duties, projects, and programs as assigned
• This position may require same-day out-of-office travel 0 - 10% 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:

• 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 when it comes to changes and maintains a positive outlook.
• Has excellent problem-solving skills.

PREFERRED QUALIFICATIONS:

• 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)
• Experience with improvement models: IHI, PDSA, Six Sigma

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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