Job Expired

Remote Manager of Quality Improvement Compliance – Project Management (Molina Healthcare)

Job Overview

  • Specialty License RN, ARNP, FNP, PMHNP, PA
  • State License(s) any

Molina Healthcare is hiring a Manager to lead their Quality Improvement Compliance team!

We are looking for candidates with the following skills:

  • Project Management and MS Project experience
  • NCQA Accreditation and Documentation experience
  • Lean Six Sigma and process improvement experience
  • Candidate with prior experience working with KPIs are highly desirable

To learn more about Molina Healthcare Careers, follow us on LinkedInTwitter & Facebook. You can also visit Molina Cares to view interactive tutorials on resume & cover letter writing, interviewing and more!

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.

The Manager, Quality Improvement Compliance assists the Director and AVP with providing the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities. The Manager serves as an internal consultant within or to the State health plans to clarify standards and resolve remediation questions.
• Manages Quality Improvement Compliance activities and staff, including developing work plans to meet NCQA and state and federal-based quality improvement compliance requirements. Ensures Molina plan(s) maintain NCQA Accreditation and, at the corporate level, brings new or acquired plans to NCQA Accredited status.
• Prepares readiness timelines and facilitates work within corporate and state plan departments to complete projects.
• Collaborates to ensure accountability for timely and accurate completion of State-mandated QI activities.
• Maintains library of accreditation and regulatory updates from NCQA, CMS and state regulators.
• Surfaces and escalates discrepancies where Health Plan policies and procedures differ materially from standard Corporate responsibilities or ensures that any differences have a sound business justification.
• Surfaces and escalates any gaps in processes that may result in gaps in member care or satisfaction.
• Works to ensure all QI compliance related activities are successfully accomplished each year, including: NCQA Accreditation, CMS Part C and D Data Validation, SNP Structure and Process, SNP Model of Care, or other activities as required.
• Develops training and coaching materials and provides training sessions to staff and other stakeholders as needed. 


Job Qualifications

Required Education
Bachelor’s Degree or equivalent work experience.
Required Experience
• 5+ years experience in managed healthcare, including at least 2 years in health plan quality improvement or equivalent/related experience.
• NCQA Accreditation experience
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).
Required License, Certification, Association
Preferred Education
Master’s Degree or higher in a clinical field, Public Health or Healthcare.

Preferred Experience
• HEDIS reporting or collection
• CAHPS improvement experience
• State QI experience.
• Provider credentialing; PQOC review
• Medicaid experience.
• Supervisory experience.
• Project management and team building experience.
Preferred License, Certification, Association
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• Certified HEDIS Compliance Auditor (CHCA)

*This is an external posting. Remote Medical Jobs has no affiliation with the company and no further information on the position. I simply find and share these jobs to the community. If interested, please apply to external link*
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