Senior National Quality Performance Manager (HEDIS)

Molina Healthcare•Long Beach, CA

12d

About The Position

Provides senior level support for Molina’s HEDIS quality performance solutions team. Collaborates with various departments and stakeholders across the enterprise to plan, coordinate, and manage resources, and execute quality performance improvement initiatives in alignment with strategic objectives.

Requirements

At least 4 years of program/project management experience in quality, including experience supporting HEDIS activities targeting and reporting, or equivalent combination of relevant education and experience.
Health care experience and functional quality knowledge.
Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server.
Intellectual agility and ability to simplify and clearly communicate complex concepts.
Proficiency with data analysis, manipulation, interpretation, and reporting.
Strong quantitative aptitude, critical-thinking, problem-solving, and analytical skills.
Attention to detail and organizational skills.
Ability to work cross-collaboratively in a highly matrixed organization.
Effective verbal, written and presentation communication skills.
Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs.

Nice To Haves

Intermediate knowledge/experience related to National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS), and state-specific regulatory submission requirements.
Microsoft Azure Databricks and SQL proficiency.
Knowledge of health care claim elements: Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine – Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), National Provider Identifiers (NPIs), Taxpayer Identification Numbers (TINs), etc.
Experience working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
Project Management Professional (PMP).
Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

Responsibilities

Collaborates with National and Health Plan quality leaders to improve outcomes by leading quality data collection strategy, analytics, and reporting for the following: quality rate trending and forecasting, provider quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement.
Ensures HEDIS quality programs are successfully delivered on time, within scope, and within resource constraints.
Oversees HEDIS quality data ingestion activities and strategies to optimize completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact.
Independently identifies, analyzes, and resolves complex quality issues using data analysis, project management skills, and cross-functional collaboration.
Leads execution of complex quality assignments, supports program changes, ensures alignment with program goals, and updates leadership and applicable parties on program/project development.
Draws actionable quality-related conclusions and recommends performance improvement initiatives.
Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines, and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success.
Partners with cross-functional teams to ensure data quality delivery through sequential transformations, draws actionable conclusions, and identifies opportunities to close quality care gaps.
Ensures that program deliverables meet all quality standards and regulatory requirements.
Creates and reviews quality-related program documentation, including plans, reports, and records, ensuring deliverables meet quality standards and regulatory requirements.
Proactively communicates risks, issues, and progress to stakeholders and escalates unresolved or high-impact concerns to leadership as appropriate.
Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.
Provides advanced subject matter support within the quality team; maintains flexibility to pivot and support other requests as needed.
Provides informal guidance and knowledge sharing to team members related to assigned quality initiatives and processes.