Health Plan Member Interventions Specialist - Health Plan Member & Community Interventions
$47.4k - $97.4k/yr
Junior
Iowa, USA
In PersonSame-day out-of-office travel may be 0–80%; occasional multi-day overnight travel may be required.
Medical, Clinical & Veterinary
About the job
Requirements
- At least 2 years of experience in health care and at least 1 year of experience in health plan quality member interventions in a managed care setting, or an equivalent combination of relevant education and experience.
- Demonstrated solid business writing experience.
- Proficiency with data analysis, manipulation, and interpretation.
- Basic knowledge and understanding of HEDIS and the National Committee for Quality Assurance (NCQA).
- Critical-thinking, problem-solving, and analytical skills.
- Attention to detail and organizational skills.
- 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.
- Proficiency with the Microsoft Office suite and applicable software programs, and ability to learn new information systems and software programs.
Responsibilities
- Develop and implement new and existing member intervention initiatives across all lines of business, including Medicare, Marketplace, and Medicaid.
- Execute health plan member and community quality-focused interventions and programs in accordance with established program standards and federal, state, and NCQA regulations.
- Conduct data collection, monitor intervention activity and key performance measurements, report intervention outcomes, and support continuous improvement of intervention processes and outcomes.
- Implement evidence-based and data-informed key member intervention strategies, including initiating and managing member and/or community interventions such as removing barriers to care, and other federal and state quality initiatives.
- Monitor and ensure key member intervention activities are completed accurately and on time, and present results to departmental management and other applicable Molina departments.
- Write narrative reports interpreting regulatory specifications, explaining programs and results, and documenting findings and limitations of department interventions.
- Create, manage, and/or compile required documentation to maintain critical program milestones, deadlines, and deliverables.
- Participate in quality improvement activities, meetings, and discussions with other departments within the organization.
- Facilitate and build strategic relationships with community-based organizations to support high-quality clinical care and services.
- Evaluate project and program activities and results to identify opportunities for improvement.
- Raise process gaps that may require remediation to quality leadership.
- Travel out of the office on the same day as needed, potentially 0–80% of the time depending on state-specific needs, and travel overnight for multiple days on occasion.
Desired Qualifications
- Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs.
- Certified Professional in Health Quality (CPHQ).
- Certified HEDIS Compliance Auditor (CHCA).
- Registered Nurse (RN); if licensed, the license must be active and unrestricted in the state of practice.
About the company
Molina Healthcare runs health insurance plans for people covered by Medicaid, Medicare and state insurance marketplaces, with a focus on people who need affordable access to care. Its local health plans coordinate medical services and support members with complex health needs, including people eligible for both Medicaid and Medicare. Members receive care through networks of doctors, hospitals and other providers, while the plans manage benefits, process claims and arrange care support. The company earns premiums from government programs and members, and pays the cost of covered healthcare services. Molina was founded in 1980 and is headquartered in Long Beach, California.
Company Size
10,001+
Company Stage
IPO
Headquarters
Long Beach, California
Founded
1980
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Simplify's Take
What believers are saying
- Illinois continuity gained ground: June 2026 brought an intended Molina Medicaid contract award for four-and-a-half years.
- Recovery has a higher target: Molina raised adjusted earnings guidance to $5.25 per share in July 2026.
- Career development has a named route: Molina's Pathways to Success helps staff navigate careers across the organization.
What critics are saying
- Profits remain under pressure: Molina reported a 76% quarterly net income decline in July 2026.
- Margins are fragile: Molina estimates one additional medical spending percentage point cuts 2025 earnings per share by $6.20.
- Remote still means travel: Molina's California site review nurse role requires field visits three to four days weekly.
What makes Molina Healthcare unique
- Pharmacy work goes outside: Molina outsources drug benefits administration to CVS Caremark.
- Wisconsin work includes long-term care: Molina's My Choice Wisconsin runs Family Care and Partnership programs.
- Connecticut retains a local brand: Molina owns ConnectiCare, a health plan focused on the state.
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Benefits
- Health Insurance
- 401(k) Retirement Plan
- Remote Work Options
- Paid Vacation
- Flexible Work Hours
- Wellness Program
- Mental Health Support
- Conference Attendance Budget
- Professional Development Budget
- Phone/Internet Stipend
- Home Office Stipend
- Family Planning Benefits