Sr Specialist, Quality Interventions/QI Compliance (Remote)

Job Description

Job Summary Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare 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 NCQA accreditation surveys and federal/state QI compliance activities. This position is seeking experience in health plan Quality compliance. Please update/include your experience on your resume. Knowledge/Skills/Abilities The Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance. • Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments. • Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities. • Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed. • Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions. • Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions. • Leads quality improvement activities, meetings, and discussions with and between other departments within the organization. • Evaluates project/program activities and results to identify opportunities for improvement. • Surfaces to Manager and Director any gaps in processes that may require remediation. • Other tasks, duties, projects, and programs as assigned. Job Qualifications Required Education Bachelor's Degree or equivalent combination of education and work experience. Required Experience • Min. 3 years’ experience in healthcare with minimum 2 years’ experience in health plan quality improvement, managed care or equivalent experience. • Demonstrated solid business writing experience. • Operational knowledge and experience with Excel and Visio (flow chart equivalent). Preferred Education Preferred field: Clinical Quality, Public Health or Healthcare. Preferred Experience • 1 year of experience in Medicare and in Medicaid. • Experience with data reporting, analysis and/or interpretation. Preferred License, Certification, Association • Active, unrestricted Certified Professional in Health Quality (CPHQ) • Active, unrestricted Nursing License (RN may be preferred for specific roles) • Active, unrestricted Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $111,967 / ANNUAL • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Apply Job!