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

Molina Healthcare•Long Beach, NY

1d•Remote

About The Position

Leads and directs the 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 role represents senior leadership at internal meetings, serves as a health plan subject matter expert at state meetings, and works with national analytics and strategic teams to evaluate quality program activities. It also maintains quality program processes and documentation, develops staff capability, tracks performance and compliance, and uses established quality-improvement methods to drive continuous improvement. Same-day out-of-office travel of approximately 0–25% and 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 of health plan quality-improvement experience, or an equivalent combination of relevant education and experience.
At least 3 years of management or leadership experience.
Advanced knowledge and understanding of HEDIS and NCQA.
Experience improving Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures.
Experience with HEDIS reporting and data collection.
Experience with government-sponsored programs, including 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.
Clinical licensure or certification only if required by state contract, regulation, business operating model, or state board licensing mandates.

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).

Responsibilities

Direct the team implementing quality program strategies, activities, surveys, audits, and other work 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 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 program management and performance activities.
Maintain quality program structures and processes, including policies and procedures, committees and workgroups, document management, reports, and deliverable tracking.
Prepare written reports and documents; ensure member and provider feedback is incorporated into quality program meetings and outcomes are documented.
Use continuous quality-improvement tools to document processes and interventions and conduct remeasurement 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, including 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.
Undertake same-day out-of-office and overnight travel as needed for health plan or state-specific requirements.