Health Plan Quality Program Mgmt & Performance Manager (Remote in TX)

Molina Healthcare•United States,

12h•$66,456 - $129,590•Remote

About The Position

Provides subject matter expertise and leadership for health plan quality management and performance improvement activities. Oversees, plans, and implements new and existing quality improvement activities to maintain compliance with quality program requirements. Monitors and reports on key quality activities and supports implementation of National Committee for Quality Assurance (NCQA) accreditation surveys and federal and state quality improvement compliance activities, including Healthcare Effectiveness Data and Information Set (HEDIS) requirements. The role drives quality program management, prepares and maintains required documentation, reports, project plans, and policy addendums, and ensures that quality activities are completed accurately and on time. It presents results to departmental leaders, stakeholders, and committees; collaborates across departments and with state and national quality leadership; evaluates program results for improvement opportunities; and supports remediation of escalations and gaps. The position also provides training and support to quality management team members. Same-day out-of-office travel of approximately 0–50% and overnight out-of-town travel of approximately 0–20% may be required, depending on health plan and state-specific needs.

Requirements

At least 6 years of experience in health care, including at least 4 years of experience in health plan quality improvement, or an equivalent combination of relevant education and experience.
Clinical licensure and/or certification only when required by state contract, regulation, business operating model, or state board licensing mandates.
Strong knowledge and understanding of HEDIS and NCQA.
Solid business writing experience.
Proficiency in data analysis, manipulation, interpretation, and reporting.
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.
Project management experience.
Strong verbal and written communication skills.
Proficiency with Microsoft Office, including Excel, and applicable software programs, and ability to learn new information systems and software programs.

Nice To Haves

Management or leadership experience.
HEDIS reporting or collection experience.
CAHPS improvement experience.
State quality improvement experience.
Experience with government-sponsored programs such as Medicaid, Medicare, or Marketplace.
Project management 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

Drive quality program management activities to ensure compliance with state, federal, and NCQA regulatory requirements.
Serve as a subject matter expert for the quality management team and support quality-related projects, programs, and initiatives.
Implement key quality program activities and prepare and finalize committee and meeting documentation, including discussions, attendee participation, follow-up actions, and next steps.
Oversee complex quality program management activities, including preparation for quality improvement reports, audits, surveys, and other required federal, state, and NCQA activities.
Monitor the timely and accurate completion of key quality activities and present results to departmental leaders, stakeholders, and formal committees and subcommittees.
Prepare narrative reports and work with the quality management team to interpret regulatory specifications, explain programs and their results, and document findings.
Maintain the quality program management project plan documenting state, federal, and NCQA requirements.
Collaborate with state and national quality leadership to maintain up-to-date addendums to quality policies and procedures that document state-specific activities and requirements.
Create, manage, and compile documentation required to maintain critical quality improvement functions.
Lead quality improvement activities, meetings, and discussions with cross-functional departments to ensure programs meet regulatory requirements.
Evaluate quality project and program activities and results to identify improvement opportunities.
Collaborate with quality leadership to solve problems and remediate escalations and gaps.
Provide training and support for new and existing quality management team members.
Travel out of the office on same-day trips approximately 0–50% of the time and overnight trips approximately 0–20% of the time, as required by health plan and state-specific needs.