Job Description

JOB DESCRIPTION

Job Summary

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. This position focuses on Quality Compliance for a health plan and requires experience within that space.

KNOWLEDGE/SKILLS/ABILITIES

The Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

• Brings extensive experience in health plan quality compliance.
• Utilizes a strong background in NCQA accreditation surveys.
• Has a strong focus on MCO Quality regulatory reporting.
• 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 key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.
• Monitors and ensures that key quality 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 quality improvement functions.
• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.
• Evaluates project/program activities and results to identify opportunities for improvement.
• Surfaces to Manager and Director any gaps in processes that may require remediation.
• Other tasks, duties, projects, and programs as assigned.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

• Min. 3 years’ experience in healthcare with minimum 2 years’ experience in health plan quality improvement, managed care or equivalent experience.
• Health Plan Quality Improvement Compliance.
• NCQA accreditation experience.
• Demonstrated solid business writing experience.
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

• Project Management in healthcare or for a health plan.
• 1 year of experience in Medicare and in Medicaid.
• Experience with data reporting, analysis and/or interpretation.

Preferred License, Certification, Association

• PMP Certification
• Active, unrestricted Certified Professional in Health Quality (CPHQ)
• Active, unrestricted Nursing License (RN may be preferred for specific roles)
• Active, unrestricted 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.

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Job Info

Job Identification: 2025755

Job Category: Quality and Risk Adjustment

Posting Date: 2024-04-26T12:18:52 00:00

Job Schedule: Full time