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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