Job Description Job Summary The Sr Specialist, Member & Community Interventions oversees and implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid). Executes health plan’s member and community quality focused interventions and programs in accordance with prescribed program standards, conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes. Acts as a lead specialist within the department and/or collaboratively with other departments. Please make sure to update your resume with any previous HEDIS/Quality experience. We look forward to reviewing! Job Duties - Acts as a lead specialist to provide project, program, and/or initiative related direction and guidance for other specialists within the department and/or collaboratively with other departments - Implements evidence-based and data-informed member intervention strategies, which may include initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state-required quality activities - Monitors and ensures that key member intervention activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed - Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions - Creates, manages, and/or compiles the required documentation to maintain critical program milestones, deadlines, and/or deliverables - Participates in quality improvement 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 - Evaluates project/program activities and results to identify opportunities for improvement - Surfaces to the Manager and Director any gaps in processes that may require remediation - Other tasks, duties, projects, and programs as assigned - 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 or equivalent combination of education and work experience. - 3 years’ experience in healthcare with a minimum of 2 years’ experience in health plan member interventions, managed care, or equivalent experience. - Demonstrated solid business writing experience. - Operational knowledge and experience with Excel and Visio (flow chart equivalent) - Demonstrates flexibility when it comes to changes and maintains a positive outlook. - Has excellent problem-solving skills. PREFERRED QUALIFICATIONS: - 1 year of experience in Medicare and in Medicaid managed care - Experience with data reporting, analysis, and/or interpretation - 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

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities As the Continuing Care LVN Coordinator, you will perform patient care management services that support the established plan of care as directed by the other licensed staff within the department. Every day, you will assist in relaying instructions from the physician to a patient or authorized person, as well as collecting patient data, documenting patient concerns, patient messages, and any instructions or education provided within the care management operational platform. The LVN will also provide leadership to support staff. To be successful, you will demonstrate outstanding assessment and communication skills, critical thinking, time-management and strong relatioship-building skills. - Conducts telephonic screenings based on criteria, refers patients to healthcare programs, specialists and other multidisciplinary team members such as a diabetes health educator, home visit provider, geriatric clinic, home health, pharmacist, etc. As per guidelines and or red flag criteria escalates to the RN or SW or supervisor when patient needs or concerns are beyond his/her scope of practice. - Assist patients and or caregivers in achieving compliance and improving adherence to plan of care notifying RN/SW or provider of issues and collaborating with multidisciplinary team members (primary care physician, social workers, pharmacists, home visit providers, etc) based on the patient's established plan of care. - Coach's patients, family and/or caregivers about the disease process including how to recognize signs and symptoms of worsening disease and next steps. Based on care plan or program criteria, identifies appropriate cases to discontinue from the program and collaborates with SW and RN to document rationale accordingly. - Serves as an advocate and liaison between patient/family and physician, hospital staff, members of the health care team, clinic care coordinators, and community resources. - Monitors member's compliance with scheduling and keeping PCP and specialist appointments identifying patterns of nonadherence and coordinates scheduling of needed member appointments. - Assists patients with navigating the healthcare system to minimize fragmentation in services, obtain timely care and appropriate access to providers, services and necessary procedures, escalating patients as per scope of practice. ***This position is work from home in California, with a preference for candidates residing in the Ventura region. Job Requirements Minimum Qualifications: - 2 years relevant experience or advanced degree required.- Graduate of an accredited LVN school.- Clear and current CA Licensed Vocational Nurse (LVN) license.- Excellent computer skills and ability to learn new systems- Strong organizational (time management) and interpersonal skills- Ability to handle multiple priorities with strong attention to detail- Ability to communicate effectively using written and verbal skills. Proficient in email communications and internet usage along with basic use of Microsoft Excel and Word- Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost)- Ability to work autonomously within a matrix environment without direct supervision or support Preferred Qualifications: - Previous care coordination experience strongly preferred. - 5+ years experience preferred. - Disease management experience a plus. - Proficiency with EHR's a plus. - Experience with Google Workspace a plus. - Bilingual in English/Spanish preferred.

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive. The Surprising Truth About Case Management - Paradigm Watch this short video for a brief introduction to role of a nurse case manager at Paradigm. We are seeking a part-time Triage Nurse. A Triage Nurse takes calls from injured workers, assesses their current medical status, applies appropriate triage protocols, and directs the injured worker to seek the appropriate level of care. The Triage Nurse follows specific account guidelines to complete the triage process. The Triage Nurse works with the injured person, the claim’s examiner, employers, and medical providers. - Schedule: - Minimum one evening shift per week - Minimum every fourth weekend - Availability to pick up additional shifts (day, evening, night) as determined by business needs - Shift differentials are included - Qualifications: - Current, unencumbered compact RN license required - Bilingual (Spanish speaking) a plus - Professional licenses or certifications required to meet qualifications for this position must be current, unrestricted and allow for practice within a state or territory of the United States. Paradigm Benefits: - Financial incentives: Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending, and employer-matched HSA contributions. - Vacation: We believe strongly that work-life balance is good for you and for our company. We offer paid time off, paid holidays, and a personal holiday. - Volunteer Time: We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year. - Learning and development: One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work. Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at leave.management@paradigmcorp.com. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (§16.765). Poster link: Contract Compliance Law Poster #LI-Remote

Role Description The Sr Specialist, Member & Community Interventions oversees and implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid). Executes health plan’s member and community quality focused interventions and programs in accordance with prescribed program standards, conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes. Acts as a lead specialist within the department and/or collaboratively with other departments. Please make sure to update your resume with any previous HEDIS/Quality experience. We look forward to reviewing! Qualifications - Bachelor's Degree or equivalent combination of education and work experience. - 3 years’ experience in healthcare with a minimum of 2 years’ experience in health plan member interventions, managed care, or equivalent experience. - Demonstrated solid business writing experience. - Operational knowledge and experience with Excel and Visio (flow chart equivalent). - Demonstrates flexibility when it comes to changes and maintains a positive outlook. - Has excellent problem-solving skills. Requirements - 1 year of experience in Medicare and in Medicaid managed care (preferred). - Experience with data reporting, analysis, and/or interpretation (preferred). - Certified Professional in Health Quality (CPHQ) (preferred). - Nursing License (RN may be preferred for specific roles) (preferred). - Certified HEDIS Compliance Auditor (CHCA) (preferred). Benefits - Molina Healthcare offers a competitive benefits and compensation package.