JOB DESCRIPTION Job Summary
Provides senior level consultant level support 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 leading
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.
Ensures quality programs are successfully delivered on time, within scope,
and within resource constraints.
Oversees quality data ingestion activities and strategies to optimize
completeness and accuracy of electronic health record (EHR)/health
information exchange (HIE) and supplemental data impact.
Independently identifies, analyzes, and resolves complex quality issues using
data analysis, project management skills, and cross-functional collaboration.
Leads execution of complex quality assignments, supports program changes,
ensures alignment with program goals, and updates leadership and applicable
parties on program/project development.
Draws actionable quality-related conclusions and recommends performance
improvement initiatives.
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, draws actionable conclusions, and identifies
opportunities to close quality care gaps.
Ensures that program deliverables meet all quality standards and regulatory
requirements.
Creates and reviews quality-related program documentation, including plans,
reports, and records, ensuring deliverables meet quality standards and
regulatory requirements.
Proactively communicates risks, issues, and progress to stakeholders and
escalates unresolved or high-impact concerns to leadership as appropriate.
Meets customer expectations and requirements, establishes, and maintains
effective relationships and gains trust and respect.
Provides advanced subject matter support within the quality team; maintains
flexibility to pivot and support other requests as needed.
Provides informal guidance and knowledge sharing to team members related to
assigned quality initiatives and processes.
Required Qualifications
At least 4 years of program/project management experience in quality,
including experience supporting HEDIS activities targeting and reporting, or
equivalent combination of relevant education and experience.
Health care experience and functional quality knowledge.
Familiarity with running queries in Microsoft Azure or Structured Query
Language (SQL) server.
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
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.
Microsoft Azure Databricks and SQL proficiency.
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), Taxpayer
Identification Numbers (TINs), etc.
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