Quality assurance tester Jobs in Rio Rancho, NM

Job DescriptionJOB DESCRIPTIONJob SummaryMolina'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 / ABILITIESThe Manager, Health Plan Quality Interventions is responsible for developing, implementing, and monitoring the success of quality improvement interventions. The Manager works to coordinate resources and training within the health plan and identify barriers to established goals and timelines. Key activities include implementing, monitoring, and analyzing the effectiveness of a comprehensive intervention strategy; and facilitating stakeholder input and strategic direction from the interventions Joint Operations Committee that includes leadership from multi-functional areas. The Manager serves as the primary contact for health plan interventions and leads the interventions Joint Operations Committee representing the Molina Plan Senior Leadership Team. In all activities, the Manager works with the national and regional collaborative analytics and strategic team to present and evaluate intervention strategies. Only individuals with an RN license are being considered at this time.

Plans and / or implements Quality interventions that meet state and federal intervention rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina plans. Develops and implements targeted interventions related to performance improvement, including member and provider outreach to improve care and service.

Serves as operations and implementation lead for Molina Plan quality improvement interventions using a defined roadmap, timeline, and key performance indicators. Collaborates with the national intervention collaborative analytics and strategic teams to deliver proposed interventions for review and evaluation. Communicates with the Molina Plan Senior Leadership Team, including the Plan President, Chief Medical Officer, national intervention collaborative analytics and strategic teams about key deliverables, timelines, barriers, and escalated issues that need immediate attention. Presents concise summaries, key takeaways, and action steps about Molina plan intervention strategy to national, regional and plan meetings. Demonstrates ability to lead and influence cross-functional teams that oversee implementation of quality interventions. Possesses a strong knowledge in quality to implement effective interventions that drive change. Functions as key lead for interventions including qualitative analysis, reporting and development of program materials, templates, or policies.

Provides on-going support to manage and maintain the integrity of established programs / processes and member / provider outreach initiatives. Supports provision of high-quality clinical care and services by facilitating / building strategic relationships with health care providers.JOB QUALIFICATIONSRequired EducationActive, unrestricted RN License. Required Experience5+ years' experience in managed healthcare, including at least 2 years in health plan quality improvement or equivalent / related experience.2+ years' management experience leading a healthcare quality team. Operational knowledge and experience with Excel and Visio (flow chart equivalent).Preferred EducationMaster's Degree or higher in a clinical field, Public Health or Healthcare.Preferred Experience 3+ years' experience with member / provider (HEDIS) outreach and / or quality intervention or improvement studies (development, implementation, evaluation). Supervisory experience. Project management and team building experience. Experience developing performance measures that support business objectives. Preferred License, Certification, Association Certified Professional in Health Quality (CPHQ) 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.