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

Molina Healthcare•New York, NY

2d•$97,299 - $227,679•Remote

About The Position

Leads and directs a team responsible for health plan quality management and quality performance improvement. Oversees, plans, and implements new and existing quality improvement activities to maintain compliance with quality program requirements, including reporting and monitoring key activities. Supports implementation of National Committee for Quality Assurance (NCQA) accreditation surveys and federal and state quality improvement compliance activities, including compliance with Healthcare Effectiveness Data and Information Set (HEDIS) regulations. The role oversees quality program management and performance activities, represents senior leadership at internal national and regional meetings, serves as a health plan subject matter expert at state meetings, and leads performance improvement projects. It works with national analytics and strategic teams to present and evaluate quality performance management program activities, maintains quality program processes and documentation, and ensures member and provider feedback informs program work. The director also manages staff training, policy and procedure updates, tracking and trending of requirements, process reviews, gap analyses, and continuous improvement efforts. 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 experience in health care, including at least 5 years in health plan quality improvement, or an equivalent combination of relevant education and experience.
At least 3 years of management or leadership experience.
Clinical licensure and/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.
Solid business writing experience.
Strong strategic-thinking skills.
Proficiency in 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.
Proficiency with Microsoft Office, including Excel, and applicable software programs, with the 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 applicable requirements.
Represent senior leadership at internal Molina 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, committee and workgroup structures, document management, report completion, and deliverable tracking.
Prepare written 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 against improvement goals.
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 in alignment with regulatory requirements.
Ensure staff understand quality program requirements and day-to-day processes supporting compliance 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 (PDSA) cycle, to facilitate individual, team, and organizational process improvement.
Hire, train, develop, and manage the team; be accountable for team performance and achievement of quality and department-specific goals.
Travel out of office or out of town as required by health plan and state-specific needs.