Description
**JOB DESCRIPTION**
**Job Summary**
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.
**KNOWLEDGE/SKILLS/ABILITIES**
The Supervisor, Quality Interventions/Compliance supervises staff who contribute to one or more of these quality improvement functions: Quality Interventions and / or QI Compliance.
Supervises other staff who have the responsibility for the implementation of key quality improvement (QI) strategies, which may include initiation and management of provider, member and/or community interventions (e. g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.
Implements Molina Healthcare goals and oversees local processes for quality interventions, accreditation, State compliance activities, CMS quality activities and/or other QI interventions or compliance duties as required.
Defines and documents QI Interventions and/or Compliance policies and procedures for the work team.
Identifies and reports gaps in processes that may result in gaps in member care or satisfaction.
Works to ensure that any differences in health plan QI processes from the standard Corporate model have sufficient justification based on market/business needs or State-specific regulations.
Provides and oversees reporting requirements to regulatory agencies.
Effectively manages internal and external vendor communications by collaborating and disseminating reports, defining program descriptions, and sharing analytical findings.
Implements, monitors, and evaluates QI interventions and/or compliance activities in consultation with the Manager, Director, and / or AVP of the department.
Works collaboratively with other Molina Health Plan and/or Corporate departments as needed to accomplish QI activities and to ensure that all tasks are accomplished timely and accurately.
**JOB QUALIFICATIONS**
**Required Education**
**Registered Nursing License.**
**2 years of leadership experience.**
**Minimum 5-7 years of clinical experience.**
Bachelor's Degree or equivalent combination of education or experience.
Required Experience
Min. 4 years' experience in healthcare with minimum 2 years' experience in health plan quality improvement, managed care or equivalent experience.
Demonstrated solid business writing experience.
Operational knowledge and experience with Excel and Visio (flow chart equivalent).
**Preferred Education**
Advanced degree in Clinical Quality, Public Health or Healthcare.
**Preferred Experience**
HEDIS reporting or collection
CAHPS improvement experience
State QI experience.
Provider credentialing; PQOC review
Medicaid experience.
Supervisory experience.
Project management and team building 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)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
\#PJQA
\#LI-AC1
Pay Range: $60,414.75 - $117,808.76 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Compensation Information:
$60414.75 / Yearly - $60414.75 / Yearly
Starting At: 60414.75 Yearly
Up To: 117808.76 Yearly
Apply on company website
Find Connections via Linkedin
