Specialist, Quality Interventions/QI Compliance

Molina Healthcare•Long Beach, WI

About The Position

JOB DESCRIPTION Job Summary Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. KNOWLEDGE/SKILLS/ABILITIES The Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance. Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities. Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed. Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions. Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions. Leads quality improvement activities, meetings, and discussions with and between other departments within the organization. Evaluates project/program activities and results to identify opportunities for improvement. Surfaces to Manager and Director any gaps in processes that may require remediation. Other tasks, duties, projects, and programs as assigned. This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location. This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

Requirements

Bachelor's Degree or equivalent combination of education and work experience.
Min. 3 years’ experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.
Demonstrated solid business writing experience.
Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Nice To Haves

Preferred field: Clinical Quality, Public Health or Healthcare.
1 year of experience in Medicare and in Medicaid.
Certified Professional in Health Quality (CPHQ)
Nursing License (RN may be preferred for specific roles)
Certified HEDIS Compliance Auditor (CHCA)

Responsibilities

Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care)
Preparation for Quality Improvement Compliance surveys
Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.
Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.
Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.
Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.
Evaluates project/program activities and results to identify opportunities for improvement.
Surfaces to Manager and Director any gaps in processes that may require remediation.
Other tasks, duties, projects, and programs as assigned.