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Job Description

Job Summary

The Specialist, Member Health & Safety monitors adherence to best practice standards in areas of member health and safety, risk assessment and mitigation, and Critical Incident reporting. This includes reviewing and monitoring of Critical Incidents and adherence to related state contractual obligations regarding Immediately Reportable incidents. Responsible for educating, advising, and consulting staff to reduce or prevent member health and safety related risk.

Job Duties

+ Review, monitor, and provide recommendations for Critical Incidents. Monitors compliance with related best practice and quality standards.

+ Complete notifications for Immediately Reportable incidents to DHS in compliance with contract requirements; provide regular updates to and serve as primary contact for DHS until incident is resolved.

+ Complete member chart reviews, when indicated, for member health and safety concerns and associated interventions. Compile and provide findings to appropriate entities as indicated. Provide timely notification to leadership when additional review is needed.

+ Provide mentoring and consultation staff as related to member health and safety; provide monitoring and oversight of member releases from correctional facilities and treatment centers; and provide consultation on member specific cases related to risk assessment and mitigation.

+ Assist with the development and maintenance of resources in the area of member health and safety to include domestic violence, law enforcement involvement, abuse, neglect, and self-neglect.

+ Attends workgroups and meetings with external organization representatives. Maintaining a continuing working relationship with external organizations and their representatives.

+ Attends regular team meetings and collaborates with peers and other departments on projects and initiatives.

+ Assists in developing policies and procedures to integrate best practices and inform staff of expected standards of practice as it relates to the Incident Management System, member health and safety, and risk mitigation. Monitor assigned compliance with best practice standards.

+ Other duties as assigned.

+ This position requires travel 10%-20% of the time.

Job Qualifications

Required Education:

+ Bachelor’s Degree in Social Work, Health & Human Service or related field or Associate Degree in Nursing.

Required Experience:

+ Three or more years of experience in long-term managed care.

Required Licensure or Certification:

A valid State Driver’s License

Required Knowledge, Skills, and Abilities:

+ The ability to be detail-oriented and solve problems in a fast-faced environment.

+ The ability to prioritize Critical Incidents and manage daily deadlines.

+ Strong organizational and follow up skills

+ Strong investigative skills.

+ Strong written and verbal communication skills

Preferred Qualifications:

+ Previous care management experience working with persons in the MCO’s target population (adults with disabilities and frail elders) in social service care management or related social service experience.

+ Understanding of Electronic Medical Records and Health Insurance Privacy and Portability Act (HIPPA).

Travel Requirements:

Driving: 20%

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: $21.82 - $42.55 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.