Description
Job Summary
- Leads 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.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V