Remote Sr Specialist, QI Compliance – Quality Data

Job Overview

  • Clinical License LPN, LVN, RN
  • State(s) Nationwide

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 Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.
• Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.
• 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 in order 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.

Job Qualifications
Required Education
Bachelor’s Degree or equivalent combination of education and work experience.
Required Experience
• Min. 3 years experience in healthcare with minimum 2 years 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).
Required License, Certification, Association
N/A
Preferred Education
Preferred field: Clinical Quality, Public Health or Healthcare.
Preferred Experience
1 year of experience in Medicare and in Medicaid.

Experience with data reporting, analysis and/or interpretation.
Preferred License, Certification, Association
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• Certified HEDIS Compliance Auditor (CHCA)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full TimePosting Date: 10/05/2020

 

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