Molina Healthcare

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)

Molina Healthcare • $75K — $95K *
Long Beach, CA 90802In-Person
Healthcare
Less than 5 years of experience
2 weeks ago
Job Overview by Ladders

Qualifications

  • 3+ years in healthcare, with 2+ years in health plan quality interventions
  • Solid business writing skills
  • Proficiency in data analysis and interpretation
  • Intermediate understanding of HEDIS and NCQA
  • Strong critical-thinking and problem-solving skills
  • Exceptional attention to detail and organization
  • Ability to adapt in a fast-paced environment

Responsibilities

  • Implement data-informed member intervention strategies
  • Monitor intervention activities for accuracy and timeliness
  • Prepare narrative reports to explain regulatory specifications
  • Manage documentation for program milestones and deadlines
  • Participate in QI activities and departmental meetings
  • Build relationships with community organizations for quality support
  • Evaluate projects to identify improvement opportunities
  • Provide training and support to team members

Benefits

  • Remote work option for Ohio residents
  • Supportive work environment with a focus on quality improvement
  • Opportunities for professional development and training
  • Engagement in community health initiatives
  • Flexibility with travel requirements based on team needs
Full Job Description
Job Description

Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health Plan Community Interventions team.
This role is remote however candidates must live in Ohio.

This role is laser focused on Quality Improvement using QI Science. This role will be assigned a primary population stream and will be expected to support improvement work for Medicare Stars Measures.

Highly qualified candidates will have the following experience-
  • Using the specific models for improvement required by the state of Ohio
  • Experience with a formal model like IHI or Lean or Six Sigma, Green or Yellow Belt Improvement
  • Power BI is helpful but expert level is not required
  • Familiarity with Medicare (Ideally the Duals population)
  • Familiarity with QI Science, Health Equity, Population Health, Health Management

This role also provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid, etc.). Executes health plan member and community quality-focused interventions and programs in accordance with established program standards, and federal/state/National Committee for Quality Assurance (NCQA) regulations. Conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Essential Job Duties
  • Implements evidence-based and data-informed key member intervention strategies including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
  • Monitors and ensures that key member intervention activities are completed on time and accurately, and presents results to key departmental management and other applicable Molina departments.
  • Writes narrative reports to interpret regulatory specifications, explains programs and results of programs, and documents findings and limitations of department interventions.
  • Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
  • Participates in quality improvement (QI) activities, meetings, and discussions with and between other departments within the organization.
  • Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs).
  • Evaluates quality project/program activities and results to identify opportunities for improvement.
  • Raises gaps in processes that may require remediation to quality leadership.
  • Provides support for quality-related projects.
  • Provides training and support to new and existing quality member interventions team members.
  • Demonstrates flexibility when it comes to change management and maintains a positive outlook.
  • This position may require same day out of office travel 0 - 80% of the time, depending upon state-specific needs.
  • This position may require multi-day overnight travel on occasion, depending upon state-specific needs.

Required Qualifications
  • At least 3 years of experience in health care, and at least 2 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
  • Demonstrated solid business writing experience.
  • Proficiency with data analysis, manipulation and interpretation.
  • Intermediate knowledge and understanding of HEDIS and NCQA.
  • Critical-thinking, problem-solving and analytical skills.
  • Attention to detail and organizational skills.
  • Ability to navigate change with flexibility and a positive outlook.
  • Ability to work independently in a fast-paced, deadline-driven environment.
  • Effective verbal and written communication skills.
  • Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications
  • Experience with data reporting, analysis, and interpretation.
  • Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs.
  • 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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Healthcare
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ
MOH
* Ladders Estimates

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