Job Description

JOB DESCRIPTION Job Summary
Provides strategy and leadership to team responsible for enterprise quality improvement (QI) activities. Responsible for overseeing, planning, and implementing new and existing health care quality improvement initiatives and education programs, and ensures maintenance of quality programs for members in accordance with established quality standards. Oversees data collection, reporting and monitoring for key performance measurement activities and member facing intervention programs, clinical performance, Healthcare Effectiveness Data and Information Set (HEDIS) compliance, and risk adjustment operations across all lines of business, including Medicare, Medicaid, and Marketplace.

Essential Job Duties
• Supports strategy development, vision and direction for enterprise-wide quality improvement (QI) initiatives. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
• Advises senior leadership, other corporate departments, and Molina health plans on QI strategies and initiatives, and oversees critical QI initiatives enterprise-wide. These functions include, but may not be limited to: quality reporting, Healthcare Effectiveness Data and Information Set (HEDIS) performance measurement, clinical quality interventions, and QI compliance.
• Collaborates with senior executives and senior leaders across Molina to set and achieve quality goals.
• Develops training, goals and coaching plans for quality staff.
• Ensures that quality assurance is performed for all reports generated by staff; examples include reports for senior leadership teams, performance measurement tracking, and medical record review completion status.
• Escalates gaps and barriers in implementation and compliance to senior quality leadership and other senior corporate leadership as appropriate.
• Serves as a subject matter expert and represents the QI function internal/external stakeholder meetings and forums.
• Collaborates and facilitates quality-related activities with corporate departments/Molina health plans.
• Identifies new QI requirements and builds out processes in advance of QI delivery effective dates.
• Hires, trains, mentors, develops and manages performance of team; demonstrates accountability for team performance/achievement of established departmental goals.
• Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.

Required Qualifications
• At least 10 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance, and at least 4 years of Medicaid/Medicare/Marketplace experience, or equivalent combination of relevant education and experience.
• At least 5 years management/leadership experience.
• Deep knowledge of the quality discipline, including metrics and performance standards.
• Advanced experience, knowledge and understanding of Star rating/QI improvement programs.
• Advanced knowledge and understanding of HEDIS/NCQA.
• NCQA Accreditation experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• State quality improvement (QI) experience.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications
• Deep QI/Stars improvement, reporting and analytics experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Knowledge of Health Outcomes Survey (HOS) and pay for performance (P4P) models.
• State QI experience.
• Health care information systems experience.
• Experience in a quality leadership role with a managed care payer with experience in all lines of business (Medicaid, Medicare, and/or Marketplace).
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, basic statistical analysis and significance concepts, provider credentialing, and potential quality of care (PQOC) review.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package.