Auditor Jobs in Jackson, MS

Job Title

Manager, Member & Community Interventions

Job Summary

The Manager, Member & Community Interventions manages the development and implementation of health plan member focused initiatives and projects supporting clinical quality outcomes. Oversees, plans, and implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid), ensures execution health plan's member and community quality focused interventions and programs in accordance with prescribed program standards. Responsible for continuous improvement. Manages robust member interventions portfolio to achieve positive operational and financial outcomes.

Job Duties

Plans and/or implements evidence based and data informed state-based Quality interventions that meet state and federal regulatory requirements

Ensures a robust and strategic portfolio of member and community quality focused interventions

Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations to drive improved clinical quality health outcomes

Develops, tracks, and reports key performance measures

Facilitates and actively participates in program discussions and activities with internal and external stakeholders

Oversees/develops and coordinates with internal stakeholders meeting agendas, minutes, and handouts; monitors action items to completion. Ensures stakeholders are engaged and prepared to report updates at regularly scheduled meetings

Responsible for maintaining the completeness and accuracy of the member interventions SharePoint site

Accountable for relevant document creation and maintenance 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 and between other departments within the organization

Collaborates across health plan teams to improve member's clinical quality outcomes (e.g., Health Care Services, Member & Community Engagement)

Develops, organizes, analyzes, documents, and implements processes and procedures as prescribed by Plan and Corporate policies

Communicates comfortably and effectively with all levels of the organization and within both the corporate and regional market environments

This position may require same day out of office travel 0 - 80% 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 in Business, Healthcare, Nursing or a related field or equivalent combination of education and relevant experience
• Minimum 5-7 years of experience in managed healthcare, including at least 4 years in health plan quality or process improvement or equivalent/related experience
• Operational knowledge and experience with Excel and Visio (flow chart equivalent)
• Demonstrated ability to lead and influence cross-functional teams that oversee implementation of quality interventions
• Possesses a strong knowledge in quality in order to implement effective interventions that drive change
• Excellent communication and presentation skills, communicating to all levels within the organization and external to the organization
• Demonstrates flexibility when it comes to changes and maintains a positive outlook
• Has excellent conflict resolution and problem-solving skills

PREFERRED QUALIFICATIONS:

• Master's Degree in Nursing, Social Work, Clinical Quality, Public Health, or Healthcare Administration
• 1-3 years' experience with member/provider (HEDIS) outreach and/or quality intervention or improvement studies (development, implementation, evaluation) and Director level experience
• Supervisory experience
• Project management and team building experience
• Experience developing performance measures that support business objectives
• Certified 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