Provides deep subject matter expertise and leadership for quality improvement (QI) activities. Responsible for new and existing health care quality improvement 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
• Leads quality programs/projects in one or more of the following critical QI functional areas: Healthcare Effectiveness Data and Information Set (HEDIS) performance measurement (includes conducting data collection, reporting and monitoring for key performance measurement (KPI) activities), quality reporting, oversight of automated quality software tools and processes, clinical quality interventions, implementation and monitoring of the success of QI activities, and QI compliance, which provides the strategic direction and implementation of corporate and/or Molina plan National Committee for Quality Assurance (NCQA) accreditation surveys and federal and state QI compliance activities.
• Serves as a quality improvement (QI) subject matter expert and leads quality programs to meet critical quality needs; advises senior leaders and other functions and departments on quality strategies and initiatives.
• In collaboration with senior quality leadership, manages QI programs and interventions.
• Collaborates and facilitates QI activities in collaboration with corporate functions and state health plans.
• Leads corporate quality initiatives - ensures timely follow-up, tracking and communications with applicable stakeholders.
• Communicates with and escalates gaps and barriers in QI implementation and compliance to department leadership, including proposed resolution.
• Monitors and tracks key quality indicators, programs and initiatives to reflect the value and effectiveness of QI programs.
• Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll-out).
• Collaborates cross-functionally to identify areas and strategies for improved reporting and use of quality reporting tools.
• Leads key clinical intervention activities including implementation of national and state-based quality interventions.
• Collaborates cross-functionally to ensure that interventions are communicated, monitored and reported on a timely basis to demonstrate program effectiveness.
• Facilitates and builds high-quality clinical care/services through relationships with key departments.
• Leads Healthcare Effectiveness Data Information Set (HEDIS) performance measurement programs - leveraging knowledge, skills and technical expertise in performance measurement, data collection and reporting.
• Provides training and support to new and existing quality team members.
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 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.
• Medicare Stars program experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• 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.
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
Skills Required
- At least 8 years of healthcare experience, including at least 5 years in health plan quality improvement or compliance, or an equivalent combination of education and experience.
- At least 3 years of management or leadership experience.
- Deep knowledge of quality disciplines, metrics, and performance standards.
- Advanced knowledge of HEDIS and NCQA, including NCQA accreditation experience.
- CAHPS improvement experience.
- HEDIS reporting and data collection experience.
- Medicare Stars program experience.
- Experience with Medicaid, Medicare, and Marketplace government-sponsored programs.
- Experience developing performance measures supporting business objectives.
- State quality improvement experience.
- Solid business writing experience.
- Strong strategic-thinking skills.
- Proficiency with data analysis, manipulation, interpretation, reporting, and data-driven decision-making.
- Critical-thinking, problem-solving, analytical, organizational, and attention-to-detail 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.
- Proficiency with Microsoft Office, including Excel, applicable software, and the ability to learn new information systems.
- Experience managing provider engagement activities, including contract development for quality performance standards.
- Deep Medicare Stars improvement, reporting, and analytics experience.
- Knowledge of Health Outcomes Survey and pay-for-performance models.
- Healthcare information systems experience.
- Quality leadership experience with a managed care payer across Medicaid, Medicare, and/or Marketplace lines of business.
- Experience with clinical interventions, quality improvement project design, target and subset populations, and basic statistical analysis.
- Certified Professional in Health Quality certification.
- Certified HEDIS Compliance Auditor certification.
- Active, unrestricted Registered Nurse license, if licensed.
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
