Senior Specialist, Health Plan Member & Community Interventions (Remote in IA)

About This Opportunity

We are representing a confidential managed care organization seeking a Senior Specialist for Health Plan Member & Community Interventions. This is a remote position based in Iowa, offering the opportunity to lead clinical quality initiatives across multiple lines of business including Medicare, Marketplace, and Medicaid programs.

In this role, you'll develop and implement member intervention strategies, conduct data analysis, monitor key performance measurements, and support continuous quality improvement processes in accordance with NCQA and federal/state regulations.

Responsibilities

• Implement evidence-based member intervention strategies including barrier removal and quality initiatives across Medicare, Marketplace, and Medicaid programs
• Monitor and ensure timely, accurate completion of key intervention activities and present results to departmental management
• Write narrative reports interpreting regulatory specifications, program outcomes, and intervention findings
• Create and manage documentation for critical program milestones, deadlines, and deliverables
• Participate in quality improvement activities and cross-departmental discussions
• Build strategic relationships with community-based organizations to support high-quality clinical care
• Evaluate quality project activities and identify opportunities for improvement
• Identify process gaps requiring remediation to quality leadership
• Provide training and support to quality member interventions team members
• Occasional same-day and overnight travel as needed (0-80% depending on state requirements)

What We're Looking For

Required:

• Minimum 3 years of healthcare experience
• Minimum 2 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of education and experience
• Demonstrated business writing skills
• Proficiency with data analysis, manipulation, and interpretation
• Intermediate knowledge of HEDIS and NCQA standards
• Strong critical-thinking, problem-solving, and analytical abilities
• Excellent attention to detail and organizational skills
• Ability to work independently in a fast-paced, deadline-driven environment
• Effective verbal and written communication skills
• Proficiency with Microsoft Office suite and ability to learn new software programs

Preferred:

• Experience with data reporting, analysis, and interpretation
• Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs
• Certified Professional in Health Quality (CPHQ)
• Certified HEDIS Compliance Auditor (CHCA)
• Registered Nurse (RN) with active, unrestricted license

How We Work With You

Our talent team at Get A Job.ai will guide you through the entire process. When you apply through our platform, a recruiter will review your qualifications and conduct an initial screening. If there's a strong match, we'll submit your profile to our client for consideration. Please do not contact the employer directly—all communication will be coordinated through Get A Job.ai to ensure the best candidate experience.

Pay

Compensation details will be discussed during the screening process based on your experience and qualifications.

Equal Opportunity: Get A Job.ai is committed to equal employment opportunity regardless of race, color, religion, sex, national origin, age, disability, veteran status, or any other protected characteristic under applicable law.