AVP, Member Interventions

Job Description

Job Summary

The AVP, Member Initiatives is an enterprise-wide risk and quality leader focused on building, delivering, and implementing all national member-facing programs.

Molina's RQS (Risk and Quality Solutions) oversees health plans, programs, and implements new and existing healthcare quality improvement initiatives and education programs to meet quality and risk adjustment goals. The department 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 strategic oversight of all member-facing intervention programs. The AVP, Member Interventions directly oversees the implementation of all national Molina member-facing quality intervention programs to support HEDIS, clinical performance, and risk adjustment operations. This includes delivery of programs for all lines of business, including Medicare, Medicaid, and Marketplace.

 

Job Duties

• Advises senior management, other corporate departments, and Molina health plans on member facing risk/quality strategies and initiatives and performs oversight over critical QI functions enterprise-wide
• Oversees the national staff delivering program setup/support and develops KPIs for performance, vendor management, and timeliness of program implementation.
• Works with senior executives, Vice Presidents, and others across Molina Healthcare to set and achieve quality goals.
• Develops training, goals, and coaching plans for member interventions staff that crosses risk adjustment and quality improvement initiatives.
• Ensures that quality assurance is performed for all reports generated by staff.
• Escalates gaps and barriers in implementation and compliance to VP, Quality, and other corporate senior management as appropriate.
• Serves as a subject matter expert and represents the QI department in meetings and discussions.
• Identifies new QI requirements and builds out processes.

 

Job Qualifications

Required Education

Master's Degree in a clinical field, IT, Public Health or Healthcare Administration or equivalent combination of education and work experience.

Required Experience

• Minimum of 10 years relevant experience, including at least 5 years in health plan quality improvement or risk adjustment operations at either a local or national level.
• 5 years Medicaid/ Medicare/Marketplace business or operations experience.
• Minimum 5 years people management experience
• Demonstrated knowledge of and experience with HEDIS intervention programs and vendor management.
• Demonstrated knowledge with the alignment of risk adjustment and quality improvement operations and implementation
• Familiarity with program implementation and life cycle design (contracting, vendor management, program delivery, KPI tracking, etc.)
• 5+ years’ experience implementing quality and/or risk intervention initiatives
• Technical experience in program design, implementation, set-up, and delivery.
• Proficiency with Excel and Visio (flow chart equivalent) and demonstrated ability to learn new information systems and software programs.

Preferred Experience

• CAHPS improvement experience
• Experience with risk adjustment programs, submission, and success criteria
• Experience with NCQA programs and processes
• National level quality improvement experience at a large payor or provider organization
• STARS improvement experience
• State QI experience
• Experience with program success metrics creation and delivery
• Health care information systems experience
• Knowledge of HOS pay for performance, basic experience with other quality metrics like PQI (hospital), NQF-sanctioned measurement.
• Working knowledge of individual state Medicaid risk adjustment operational components as well as federal standards for Marketplace and Medicare risk operations.
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
• Experience with aligned risk adjustment and quality metrics performance and program implementation.

Preferred License, Certification, Association

Certified Professional in Health Quality (CPHQ)

 

 

 

 

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

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