Specialist, Quality Interventions / QI Compliance (Remote)

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 Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions : Quality Interventions and Quality Improvement Compliance. + 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 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. This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location. This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

Job Qualifications

Required Education : Bachelor's Degree or equivalent combination of education and work experience. Required Experience : + Min. 3 years' experience in healthcare with 1 year 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). Preferred Education : Preferred field : Clinical Quality, Public Health or Healthcare. Preferred Experience : 1 year of experience in Medicare and in Medicaid. Preferred License, Certification, Association : + Certified Professional in Health Quality (CPHQ) + Nursing License (RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA)