Senior Specialist, Member
4 weeks ago
Sr Specialist, Member & Community InterventionsThe 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.Job DutiesActs 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 departmentsImplements 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 activitiesMonitors 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 neededWrites narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventionsCreates, manages, and/or compiles the required documentation to maintain critical program milestones, deadlines, and/or deliverablesParticipates in quality improvement activities, meetings, and discussions with and between other departments within the organizationSupports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizationsEvaluates project/program activities and results to identify opportunities for improvementSurfaces to the Manager and Director any gaps in processes that may require remediationOther tasks, duties, projects, and programs as assignedThis position may require same-day out-of-office travel 0 - 80% of the time, depending upon locationThis position may require multiple days out-of-town overnight travel on occasion, depending upon locationJob QualificationsRequired QualificationsBachelor'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 Qualifications1 year of experience in Medicare and in Medicaid managed careExperience with data reporting, analysis, and/or interpretationCertified Professional in Health Quality (CPHQ)Nursing License (RN may be preferred for specific roles)Certified HEDIS Compliance Auditor (CHCA)Molina Healthcare offers a competitive benefits and compensation packageMolina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/VPay Range: $52,176 - $107,098 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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