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.
The Manager, Quality Interventions assists the Director and AVP in developing, implementing and monitoring the success of Molina national and/or plan-level Quality Improvement activities, including intervention projects, problem resolution and management of staff and contractors. The Manager works directly with/within Molina's health plans to coordinate resources and training and identify barriers to established goals and timelines.
• Plans and/or implements national and/or state-based Quality interventions that meet state and federal intervention rules and are aligned with best practices as identified in the healthcare quality improvement literature and within Molina plans.
• Ensures Molina plan(s) are held accountable for timely and accurate completion of state-mandated Quality activities.
• Develops and implements targeted interventions related to HEDIS performance improvement, including member and provider outreach to improve care and service.
• Functions as key lead for QI Interventions including qualitative analysis, reporting and development of program materials, templates or policies. Provides on-going support to manage and maintain the integrity of established programs/processes and member/provider outreach initiatives.
• Develops and implements MHI medical record pursuit strategies and processes and oversees their operations in collaboration with the HEDIS Operations team. Assists with integration of strategic partners, acquisitions and start-up plans relative to HEDIS medical records collection/abstraction.
• Supports provision of high quality clinical care and services by facilitating/building strategic relationships with health care providers.
• Chairs collaborative workgroups to develop strategies for effective QI Intervention programs; interfaces and supports other medical care management, disease management or care coordination activities; oversees scheduling, execution and follow-up for regulators, physicians, nurses, pharmacist and providers.
• Conducts periodic audits/reviews of established MHI and Plan programs for efficiency, effectiveness and adherence to policy. Makes written recommendations to be used system-wide for process improvement purposes.
Bachelor's Degree or equivalent work experience.
• 5+ years experience in managed healthcare, including at least 2 years in health plan quality improvement or equivalent/related experience.
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).
Required License, Certification, Association
Master's Degree or higher in a clinical field, Public Health or Healthcare.
• 3+ years experience with member/ provider (HEDIS) outreach and/or quality intervention or improvement studies (development, implementation, evaluation).
• Supervisory experience.
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
Preferred License, Certification, Association
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• 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.
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