$80K — $100K *
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.
The Supervisor, HEDIS/Quality Reporting supervises staff who contribute to one or more of these quality improvement functions: HEDIS Performance Measurement and Quality Reporting.
• Supervises staff who have the responsibility for the implementation of HEDIS activities, including the identification, collection and abstraction of medical records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers.
• Implements Molina Healthcare goals and / or oversees local processes for HEDIS and / or Quality Reporting.
• Participates in meetings with the corporate HEDIS team, vendors and / or HEDIS auditors. Works with QI management to provide medical record vendor oversight.
• Provides data collection and / or report development support for Quality Improvement studies and performance improvement project.
• Ensures all data-intensive HEDIS and / or reporting activities are accomplished timely and accurately.
• Identifies and oversees new supplemental data sources for use in HEDIS reporting.
• Coordinates HEDIS and QI related projects to meet customers' expectations.
• Ensures standard rate validations are completed in conjunction with reporting.
• Works with other Health Plan and / or Corporate departments (e.g., Risk Adjustment) to ensure prospective and / or retrospective chart reviews and completed timely and accurately.
• Effectively oversees internal and / or external vendor communications by collaborating and disseminating reports, defining program descriptions, and / or sharing analytical findings.
• Bachelor's degree in related field or equivalent experience, OR completion of any of the following programs:
• Registered Nurse (RN) or State Licensed Vocational Nurse (LVN), or
• Registered Health Information Technician (RHIT), or
• Certified Medical Record Technician with training in coding procedures (as required by state/location only), or
• Certified Professional Coder (CPC)
• Min. 4 years experience in healthcare with minimum 2 years experience in health plan quality improvement, managed care or related experience.
• 2+ years of experience in HEDIS medical records collection and abstraction
• 2+ years of medical record review experience
Required License, Certification, Association
Preferred field: Clinical Quality, Public Health or Healthcare.
• CAHPS improvement experience
• State QI experience
Preferred License, Certification, Association
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• Certified HEDIS Compliance Auditor (CHCA).
Valid through: 5/19/2021