JOB DESCRIPTION
Provides subject matter expertise for Molina's quality performance solutions
team. Collaborates with various departments and stakeholders across the
enterprise to plan, coordinate, and manage resources, and execute quality
performance improvement initiatives in alignment with strategic objectives.
Essential Job Duties
Collaborates with health plan quality leaders to improve outcomes by managing
quality data collection strategy, analytics, and reporting for the following:
quality rate trending and forecasting, provider quality measurement
performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS)
and survey analytics, health equity and social determinants of health (SDOH),
and external vendor engagement.
Monitors quality-related projects from inception through successful delivery.
Oversees quality data ingestion activities through data validation, issue
identification, and documentation to improve completeness and accuracy of
electronic health record (EHR)/health information exchange (HIE) and
supplemental data impact.
Analyzes quality data and identifies potential performance improvement
opportunities.
Ensures compliance with all quality-related regulatory audit guidelines by
adhering to roadmap of deliverables and timelines, and implements solutions
to maximize national Healthcare Effectiveness Data and Information Set
(HEDIS) audit success.
Partners with cross-functional teams to ensure data quality delivery through
sequential transformations and identifies opportunities to close quality care
gaps.
Creates, reviews, and updates quality-related program documentation,
including plans, reports, and records, and ensures information is accessible
for quality teams throughout the enterprise.
Proactively communicates regular quality-related status reports to
stakeholders, highlighting progress, risks, and issues.
Meets customer expectations and requirements, establishes, and maintains
effective relationships and gains trust and respect.
Required Qualifications
At least 3 years of program/project management experience in quality, or
equivalent combination of relevant education and experience.
Health care experience or demonstrated functional quality knowledge.
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.
Attention to detail and organizational skills.
Ability to work cross-collaboratively in a highly matrixed organization.
Effective 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
Familiarity with running queries in Microsoft Azure or Structured Query
Language (SQL) server.
Intermediate 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.
Knowledge of health care claim elements: 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 working in a cross-functional, highly matrixed organization,
preferably within a managed care organization supporting Medicaid, Medicare,
and/or Marketplace programs.
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