Job DescriptionJob SummaryLeads and directs team responsible for quality interventions activities. Responsible for planning, implementing, and overseeing new and existing health care quality improvement (QI) 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 National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state QI compliance activities.
Essential Job Duties• In collaboration with senior quality leadership, plans and/or implements national and/or state-based quality interventions (QI) that meet state and federal intervention rules aligned with established quality-related best practices, including intervention projects and problem resolution.
• Develops and implements targeted interventions related to Healthcare Effectiveness Data and Information Set (HEDIS) performance improvement, including member and provider outreach to improve care and service.
• Serves as operations and implementation lead for QI using a defined roadmap, timeline and key performance indicators (KPIs).
• Represents as designated quality lead at internal Molina national and regional meetings, and serves as subject matter expert for the health plans at state meetings; actively oversees the completion of effective performance improvement projects.
• Serves as the primary contact for interventions, including qualitative analysis, reporting and development of program materials, templates and/or policies; provides ongoing support to manage and maintain the integrity of established programs/processes and member/provider outreach initiatives, and leads the interventions Joint Operations Committee (JOC).
• Collaborates with the national intervention collaborative analytics and strategic teams to deliver proposed interventions for review and evaluation.
• Collaborates with senior leaders and the national intervention collaborative analytics and strategic teams on key quality deliverables, timelines, barriers and escalated issues.
• Presents concise summaries, key takeaways and action steps related to plan intervention strategies at national/health plan meetings.
• Ensures Molina health plans are held accountable for timely and accurate completion of state-mandated quality activities.
• Collaborates directly with Molina health plans to coordinate resources and training, and identify barriers to established quality goals and timelines.
• Develops and implements Molina medical record pursuit strategies and processes, and oversees record operations in collaboration with the HEDIS operations team; assists with integration of strategic partners, acquisitions and start-up plans relative to HEDIS medical records collection/abstraction.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with health care providers.
• Chairs collaborative workgroups to develop strategies for effective QI intervention programs; interfaces and supports other medical care management, disease management or care coordination activities; oversees scheduling, execution and follow-up for regulators, physicians, nurses, pharmacists and providers.
• Conducts periodic audits/reviews of established corporate and health plan programs for efficiency, effectiveness and adherence to policy, and provides recommendations to be used system-wide for process improvement purposes.
• Hires, trains, mentors, develops and manages performance of team; demonstrates accountability for team performance/achievement of established departmental goals.
Required Qualifications• At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Deep knowledge of the quality discipline, including metrics and performance standards.
• Advanced knowledge and understanding of HEDIS/NCQA, including 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).
• Medicare Stars program experience.
• 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• Experience in managing provider engagement activities including contract development for quality performance standards.
• Deep 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.
• 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, and basic statistical analysis and significance concepts.
• 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.
- Experience with Power BI reporting.
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.
