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 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 remediationDemonstrates flexibility when it comes to changes and maintains a positive outlookOther 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 location

Job Qualifications

REQUIRED QUALIFICATIONS:

Associate’s degree or equivalent combination of education and work experience1-3 years’ experience in healthcare with 1-year experience in health plan quality member interventions, managed care, or equivalent experienceDemonstrated solid business writing experienceOperational 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 Administration1 year of experience in Medicare and in Medicaid managed careCertified 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.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 05/29/2025