Director, Health Plan Quality Program Management & Performance (Remote in New York)

Molina Healthcare•Long Beach, CA

2d•Remote

About The Position

Leads and directs a team responsible for health plan quality management and performance improvement. Oversees the planning and implementation of new and existing quality improvement activities to maintain compliance with quality program requirements, reporting, and monitoring. Supports implementation of NCQA accreditation surveys and federal and state quality improvement compliance activities, including HEDIS regulations. The position also maintains quality program structures and processes, develops staff capability, tracks performance and compliance, and drives continuous improvement across the organization. Same-day out-of-office travel of approximately 0–25% and multi-day overnight travel of approximately 0–20% may be required depending on health plan and state-specific needs.

Requirements

At least 8 years of healthcare experience, including at least 5 years of health plan quality improvement experience, or an equivalent combination of relevant education and experience.
At least 3 years of management or leadership experience.
Clinical licensure or certification only if required by state contract, regulation, business operating model, or state board licensing mandates.
Advanced knowledge and understanding of HEDIS and NCQA.
Experience with CAHPS improvement.
Experience with HEDIS reporting and collection.
Experience with government-sponsored programs such as Medicaid, Medicare, or Marketplace.
State quality improvement experience.
Strong business writing, strategic-thinking, data analysis, data manipulation, data interpretation, reporting, and data-driven decision-making skills.
Critical-thinking, problem-solving, analytical, 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 and within a cross-functional, highly matrixed organization.
Project management experience.
Excellent verbal and written communication skills.
Proficiency with Microsoft Office, including Excel, and applicable software; ability to learn new information systems and software programs.

Nice To Haves

Demonstrated experience leading significant cross-functional work.
Provider credentialing and subcontractor monitoring experience.
Certified Professional in Health Quality (CPHQ).
Certified HEDIS Compliance Auditor (CHCA).
Registered Nurse (RN); if licensed, the license must be active and unrestricted in the state of practice.

Responsibilities

Direct the team implementing quality program management strategies, activities, surveys, and audits to meet state, federal, and NCQA requirements.
Oversee health plan quality program management and performance activities in compliance with state, federal, and NCQA quality requirements.
Represent senior leadership at internal national and regional meetings and serve as the health plan subject matter expert at state meetings.
Oversee effective performance improvement projects.
Collaborate with national analytics and strategic teams to present and evaluate quality performance management program activities.
Maintain quality program management structures and processes, including policies and procedures, committees and workgroups, document management, reports, and deliverable tracking.
Prepare reports and documents describing quality program activities; incorporate member and provider feedback, document outcomes, and use continuous quality improvement tools to track processes, interventions, and remeasurements.
Oversee ongoing revision of policies and procedures to reflect state, federal, and NCQA requirements, including state-specific policy addendums.
Manage training and education for quality program management and performance staff.
Ensure staff understand quality program requirements and day-to-day processes needed to comply with state contracts, policies, procedures, and program requirements.
Track and trend quality program requirements, operational KPIs, process reviews, and gap analyses.
Use quality improvement methods such as the plan-do-study-act cycle to facilitate individual, team, and organizational process improvement.
Hire, train, develop, and manage the team, and be accountable for team performance and achievement of quality and department-specific goals.