Senior Specialist, Health Plan Member & Community intervention-New Mexico

About the role

Provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid, etc.). Executes health plan member and community quality-focused interventions and programs in accordance with established program standards, and federal/state/National Committee for Quality Assurance (NCQA) regulations. Conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Responsibilities

• Implements evidence-based and data-informed key member intervention strategies including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
• Monitors and ensures that key member intervention activities are completed on time and accurately, and presents results to key departmental management and other applicable Molina departments.
• Writes narrative reports to interpret regulatory specifications, explains programs and results of programs, and documents findings and limitations of department interventions.
• Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
• Participates in quality improvement (QI) 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 (CBOs).
• Evaluates quality project/program activities and results to identify opportunities for improvement.
• Raises gaps in processes that may require remediation to quality leadership.
• Provides support for quality-related projects.
• Provides training and support to new and existing quality member interventions team members.
• Demonstrates flexibility when it comes to change management and maintains a positive outlook.
• This position may require same day out of office travel 0 - 80% of the time, depending upon state-specific needs.