Manager, Quality Improvement Compliance (Remote)

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 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).

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)

 

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.