Manager, Health Plan Member & Community Interventions

JOB DESCRIPTION 

****Employee for this role must reside in Mississippi****

Job Summary

Leads and manages team responsible 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.

 

Essential Job Duties

• Develops and implements evidence-based and data informed state-based quality interventions that meet state and federal regulatory requirements.
• Manages a robust and strategic portfolio of member and community quality focused interventions to achieve positive operational and financial outcomes.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs) to drive improved clinical quality health outcomes.
• Develops, tracks, and reports quality key quality performance measures.
• Facilitates and actively participates in quality program discussions and activities with internal and external stakeholders.
• Oversees, develops and coordinates quality-related initiatives with internal stakeholders, includes support for meeting agendas, minutes, and materials; monitors action items to completion, and ensures stakeholders are engaged and prepared to report updates at regularly scheduled meetings.
• Maintains the completeness and accuracy of the member interventions SharePoint site.
• Creates and maintains documentation related to health plan interventions.
• Ensures all documents are appropriately approved by Molina and/or state regulatory agencies as required by policy.
• Leads or participates in quality improvement activities, meetings, and discussions with other departments.
• Collaborates across health plan teams to improve member clinical quality outcomes (e.g., healthcare services, growth and community engagement, network, etc.).
• Hires, trains, mentors, develops, and performance manages quality team; demonstrates accountability for team performance/goal achievement.
• This position may require same day out of office travel 30-40% within Mississippi.
• This position may require multi-day overnight travel on occasion, depending upon state-specific needs.
 

Required Qualifications

• At least 7 years of experience in health care, and at least 4 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience. 
• At least 1 year management/leadership experience.
• Ability to lead and influence cross-functional teams that oversee implementation of quality interventions.
• Proficiency with data analysis, manipulation and interpretation.
• Intermediate knowledge and understanding of HEDIS and NCQA.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Ability to navigate change with flexibility and a positive outlook.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.
 

Preferred Qualifications

• Experience with member/provider (Healthcare Effectiveness Data and Information Set (HEDIS)) outreach and/or quality interventions or improvement studies (development, implementation, evaluation).
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
• Certified Professional in Health Quality (CPHQ)
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN).  If licensed, license must be active and unrestricted in state of practice.
 

 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V