Molina Healthcare-posted 3 months ago
$122,430 - $238,739/Yr
Full-time • Senior
Omaha, NE
Insurance Carriers and Related Activities

Serve as a leader of health plan Quality strategy and activities, including but not limited to leadership and primary Molina interface with state agencies, leadership of local Quality committees and oversight of intervention activities intended to improve quality measures and outcomes. The Quality AVP will collaborate with MHI Quality leaders to conduct data collection, reporting and monitoring for key Quality performance measurement activities. The Quality leader will coordinate with and receive direction from MHI Quality leaders on the implementation of NCQA accreditation surveys and federal QI compliance activities. The Quality AVP will be responsible for Medicare Stars strategies and performance improvement. If appropriate, based on volume, the Quality AVP will manage Critical Incidents (CIs) and Potential Quality of Care (PQOC) issues locally. Must be state licensed RN, Physician, PA or CPHQ certified.

  • Serve as the primary contact to State agencies for all Quality matters.
  • Lead the local Quality committees.
  • Prepare required documentation for state Performance Improvement Projects in collaboration with MHI Quality.
  • Design, implement, monitor, and analyze the effectiveness of a comprehensive Quality intervention strategy.
  • Collaborate with national, regional, and state analytics and strategic teams to develop, present and evaluate intervention strategies.
  • Support accreditation activities led by MHI Quality with local resources and leadership.
  • Plan and implement evidence-based quality intervention strategies and initiatives.
  • Serve as operations and implementation lead for Molina plan quality improvement activities.
  • Communicate with the Plan President and senior leadership about key deliverables and issues.
  • Establish QI benchmarks and requirements for VBC contracts with Plan Network leadership.
  • Develop and execute the local Medicare Stars work plan.
  • Monitor Part D and Operational health insurance metrics.
  • Manage MMP quality withhold revenue in MMP States.
  • Collaborate with MHI quality analytics for broad-based quality data analytics.
  • Oversee local resources for HEDIS abstractions and customized reports.
  • Present summaries and action steps about Molina quality strategy to various meetings.
  • Lead and influence cross-functional teams for quality interventions.
  • Collaborate and educate network providers on quality improvements.
  • Attend State and regional Quality Improvement and/or Board of Directors Meetings.
  • Represent Molina in external forums and statewide conferences.
  • Lead Critical Incident and PQOC investigation and reporting.
  • Master's Degree or equivalent.
  • Deep knowledge of Quality Discipline including metrics and performance standards.
  • Project management experience in a managed healthcare setting.
  • 3 - 5 years in quality compliance/HEDIS operations, customer service or provider service in a managed care setting with AVP level experience.
  • Required License: RN or CPHQ.
  • 10+ years' experience in managed healthcare administration.
  • 10+ years' experience in Quality leadership role with a Managed Care Payer.
  • Competitive benefits and compensation package.
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