Job Description
Leads and directs team responsible for Molina enterprise clinical data acquisition activities. Responsible for implementing, monitoring, and overseeing chart collection for Healthcare Effectiveness Data and Information Set (HEDIS), and HEDIS-like projects, risk adjustment, risk adjustment data validation, and other state-specific audit projects and deliverables. Collaborates with health plan quality leads to strategically plan for supplemental data source (SDS) acquisition from providers and Electronic Medical Record (EMR) access. Oversees HEDIS-related training, vendor chart collection, invoice efforts, and SDS and EMR implementations.
Essential Job Duties
• Plans and/or implements operational processes for HEDIS operations that meet state and federal reporting requirements/rules, aligned with effective practices as identified in health care quality improvement literature and Molina health plans.
• Develops and implements targeted collection of clinical data acquisition related to performance reporting and improvement, including member and provider outreach.
• Serves as a subject matter expert (SME) for Molina health plan quality improvement HEDIS operations using a defined roadmap, timeline and key performance indicators (KPIs).
• Collaborates with the national intervention collaborative analytics and strategic teams to deliver value for both prospective and retrospective programs.
• Communicates with health plan senior leadership teams, national intervention teams and strategic teams on key deliverables, timelines, barriers and escalated issues that need immediate attention.
• Presents concise summaries, key takeaways and action steps related to Molina HEDIS processes, strategy and progress at national, regional and plan meetings.
• Demonstrates ability to lead and influence cross-functional teams that oversee implementation of quality projects.
• Leverages deep knowledge in quality to implement effective initiatives that drive change.
• Oversees clinical chart review/abstraction; includes qualitative analysis, reporting and development of program materials, templates or policies, and productivity reporting.
• Maintains advanced ability to collaborate and manage production vendor relationships, including oversight, data-driven key performance indicators (KPIs) measurement and performance mitigation strategies.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality/department-specific goals.
Required Qualifications
• At least 8 years of experience in managed care quality, including at least 4 years in health plan quality or process improvement, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates
• Advanced experience with HEDIS programs.
• Technical experience in reporting and/or programming.
• Advanced data analysis, manipulation and interpretation experience.
• Critical-thinking and problem-solving skills.
• Attention to detail and organizational/time-management skills.
• Ability to work in a cross-functional highly matrixed environment.
• Excellent verbal/written communication, and presentation skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.
Preferred Qualifications
• Medicare STAR program/CAHPS improvement experience.
• Experience with member/provider (HEDIS) outreach and/or quality intervention/improvement studies (development, implementation, evaluation).
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, licensed 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.
