Job Description
Job Summary
Leads and manages Quality Systems performance managers, demonstrating
accountability for people performance, delivery outcomes, and execution of
quality system initiatives. Oversees a portfolio of quality data and performance
improvement activities, ensuring teams are resourced, aligned, and operating in
accordance with quality strategies, regulatory requirements, and enterprise
priorities.
Job Duties
Manages the Quality Systems team, including setting expectations, monitoring
performance, providing coaching and feedback, and ensuring alignment with
quality strategies and department specific goals.
Supports the annual quality data submission process, including National
Committee for Quality Assurance (NCQA) and state regulatory submissions.
Manages, designs, and develops data-focused strategies to improve
completeness and accuracy of data ingestion activities including supplemental
and Health Information Exchange (HIE) data.
Collaborates with corporate quality leaders and health plans to improve
program performance by supporting development of meaningful reporting and
analytics including but not limited to: quality rate trending and
forecasting, provider quality performance, Consumer Assessment of Healthcare
Providers and Systems (CAHPS) and other survey analytics, and health equity.
Oversees development of quality project plans and schedules, assigns
resources, and ensures deliverables are met on time, within scope, and in
compliance with regulatory requirements.
Identifies potential barriers to quality project plans and develops
mitigation strategies.
Ensures complex problems are addressed and resolved by the team through
effective prioritization, escalation, and cross-functional collaboration.
Draws actionable conclusions and collaborates with cross-functional teams to
present recommendations/solutions to identify quality issues.
Conducts regular quality-related reviews and audits to maintain high
standards of performance.
Addresses issues/discrepancies promptly to ensure quality program success.
Develops data quality strategies and solutions to close quality care gaps.
Communicates effectively and consistently with leadership and key
stakeholders regarding portfolio status, risks, dependencies, and recommended
remediation approaches.
Fosters a collaborative and high-performing team and promotes professional
development and knowledge sharing within the team.
Hires, trains, develops and manages team; demonstrates accountability for
team performance and achievement of quality department-specific goals.
Job Qualifications
REQUIRED QUALIFICATIONS:
At least 7 years of program/project management experience in quality,
including experience supporting HEDIS activities targeting and reporting, or
equivalent combination of relevant education and experience.
At least 1 year of management/leadership experience.
Comprehensive mastery of the drivers of value in managed health care, and
in-depth knowledge of quality and the health care industry.
Extensive knowledge and mastery of the nuances of health care claim elements
including: Current Procedural Terminology (CPT), CPT Category II (CPTII),
Logical Observation Identifiers Names and Codes (LOINC), Systematized
Nomenclature of Medicine - Clinical Terms (SNOMED), Healthcare Common
Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX),
National Provider Identifiers (NPIs), and Taxpayer Identification Numbers
(TINs).
Experience running queries in Microsoft Azure or Structured Query Language
(SQL) server.
Ability to assess impact cross-functionally, identify costs/benefits to
upstream and downstream stakeholders, and solution benefits to multiple
business areas.
Intellectual agility and ability to simplify and clearly communicate complex
concepts.
Proficiency with data analysis, manipulation, interpretation, and reporting.
Strong quantitative aptitude, critical-thinking, problem-solving, and
analytical skills.
High attention to detail and organizational skills.
History of partnering with various levels of leadership across complex
organizations, and ability to work cross-collaboratively in a highly matrixed
organization.
Strong verbal, written and presentation communication skills.
Microsoft Office suite (including Excel) and applicable software programs
proficiency, and ability to learn/navigate new software programs.
PREFERRED QUALIFICATIONS:
Experience leading in a cross-functional, highly matrixed organization,
preferably within a managed care organization supporting Medicaid, Medicare,
and/or Marketplace programs.
History of excelling in roles impacting quality.
Advanced knowledge/experience related to National Committee for Quality
Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS),
Centers for Medicare and Medicaid Services (CMS), and state-specific
regulatory submission requirements.
Microsoft Azure Databricks and SQL mastery.
Project Management Professional (PMP).
Six Sigma Green Belt or Black Belt certification, and/or comparable
coursework.
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.