Molina Healthcare is hiring for a Health Plan Quality Program Mgt & Performance
Manager. This position is remote; however candidates must reside in Michigan.
Highly Qualified Candidates Will Have the Following –
Michigan Medicaid and/or Managed Care experience
Experience focusing on QI compliance deliverables, specifically related to
State and Federal regulators
Experience with NCQA/HEDIS in relation to QI
Strong communication skills, both written and verbal
Previous experience in a detail orientated role that also handles tight
deadlines
Experience managing multiple high-priority deliverables and working with
others to meet deadlines
Provides subject matter expertise and leadership for quality management and
quality performance improvement activities. Responsible for overseeing,
planning, and implementing new and existing health plan quality improvement
activities to maintain compliance with quality program requirements and
reporting and monitoring for key quality program activities, and provides
support and implementation of National Committee for Quality Assurance (NCQA)
accreditation surveys and federal/state quality improvement compliance
activities, including compliance with Healthcare Effectiveness Data and
Information Set (HEDIS) regulations.
Essential Job Duties
• Drives quality program management activities to ensure compliance with state,
federal and National Committee for Quality Assurance (NCQA) regulatory
requirements.
• Represents as a subject matter expert to quality management team; provides
support for quality-related projects, programs and initiatives, and ensures
quality programs meet regulatory requirements.
• Implements key quality program activities that maintain quality compliance;
includes maintaining responsibility for preparing and finalizing quality program
management committee and other meeting documentation, capturing thorough
discussion and participation of attendees, follow-up actions, and documenting
next steps in a clear and understandable manner.
• Oversees higher complexity quality program management activities, which
include preparation for quality improvement reports, audits, surveys, and other
federal, state, and NCQA required quality activities.
• Monitors and ensures that key quality activities are completed on time and
accurately, and presents results to key departmental leaders, stakeholders, and
formal committees and subcommittees.
• Prepares narrative reports, and works collaboratively with the quality
management team to interpret regulatory specifications, explain programs and
results of programs, and document findings.
• Maintains quality program management project plan to ensure state, federal,
and NCQA-related requirements are documented.
• Collaborates with state and national quality leadership to maintain up-to-date
addendums to quality policies and procedures that clearly document
state-specific activities and requirements.
• Creates, manages, and/or compiles required documentation to maintain critical
quality improvement functions.
• Leads quality improvement activities, meetings, and discussions with
cross-functional departments within the organization to ensure quality programs
meet regulatory requirements.
• Evaluates quality project/program activities and results to identify
opportunities for improvement.
• Engages in problem-solving and remediation of escalations/gaps in
collaboration with quality leadership.
• Provides training and support for new and existing quality management team
members.
• Same-day out-of-office travel approximately 0-50% of the time may be required,
depending on health plan/state-specific needs.
• Multi-day out of town overnight travel approximately 0-20% of the time may be
required, depending upon health plan/state-specific needs.
Required Qualifications
• At least 6 years of experience in health care, with at least 4 years of
experience in health plan quality improvement, or equivalent combination of
relevant education and experience.
• Clinical licensure and/or certification required ONLY if required by state
contract, regulation, business operating model, or state board licensing
mandates
• Strong knowledge and understanding of HEDIS/NCQA.
• Solid business writing experience.
• Proficiency with data analysis, manipulation, interpretation and reporting.
• 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.
• Project management experience.
• Strong 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
• Management/leadership experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection
experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement
experience.
• State quality improvement (QI) experience.
• Experience with government-sponsored programs (Medicaid, Medicare,
Marketplace).
• Project management experience.
• 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. Molina
Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V