Specialist, Quality Interventions / QI Compliance (Remote)

Quality Interventions / Qi Compliance Specialist

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.

The Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions :

• Implements key quality strategies, which may include initiation and management of provider, member and / or community interventions; 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.

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)

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. Pay Range : $21.82 - $42.55 / HOURLY