Sr Specialist, Quality Interventions/QI Compliance

Welcome to Molina Healthcare: A Leader in Quality Improvement

Molina Healthcare is a renowned organization dedicated to providing high-quality healthcare services to its members. Our Quality Improvement function plays a vital role in overseeing, planning, and implementing new and existing healthcare quality improvement initiatives and education programs. We are committed to ensuring the maintenance of programs for members in accordance with prescribed quality standards, conducting data collection, reporting, and monitoring for key performance measurement activities, and providing direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

Job Summary

We are seeking a highly skilled and experienced Senior Specialist, Quality Interventions / QI Compliance to contribute to our quality improvement functions. As a lead specialist, you will provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments. Your expertise will be crucial in implementing key quality strategies, monitoring and ensuring that key quality activities are completed on time and accurately, and presenting results to key departmental management and other Molina departments as needed.

Key Responsibilities:

• Act as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.
• Implement 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.
• Monitor and ensure that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.
• Write narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.
• Create, manage, and/or compile the required documentation to maintain critical quality improvement functions.
• Lead quality improvement activities, meetings, and discussions with and between other departments within the organization.
• Evaluate project/program activities and results to identify opportunities for improvement.
• Surface to Manager and Director any gaps in processes that may require remediation.
• Perform other tasks, duties, projects, and programs as assigned.

Essential Qualifications:

To be successful in this role, you will need:

• A Bachelor's Degree or equivalent combination of education and work experience.
• Minimum 3 years' experience in healthcare with minimum 2 years' 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 Qualifications:

While not required, the following qualifications are preferred:

• Preferred field: Clinical Quality, Public Health or Healthcare.
• 1 year of experience in Medicare and in Medicaid.
• Experience with data reporting, analysis and/or interpretation.
• Active, unrestricted Certified Professional in Health Quality (CPHQ)
• Active, unrestricted Nursing License (RN may be preferred for specific roles)
• Active, unrestricted Certified HEDIS Compliance Auditor (CHCA)

Skills and Competencies:

To excel in this role, you will need to possess:

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Strong project management skills.
• Ability to prioritize tasks and manage multiple projects simultaneously.
• Strong attention to detail and organizational skills.

Career Growth Opportunities and Learning Benefits:

• Opportunities for professional growth and advancement.
• Comprehensive training and development programs.
• Mentorship and coaching from experienced professionals.
• Recognition and reward for outstanding performance.

Work Environment and Company Culture:

Molina Healthcare is a dynamic and supportive work environment that values diversity, equity, and inclusion. Our company culture is built on:

• A commitment to excellence and quality.
• A passion for improving the lives of our members.
• A collaborative and team-oriented approach.
• A focus on employee well-being and work-life balance.

Compensation, Perks, and Benefits:

We offer a competitive benefits and compensation package, including:

• A competitive salary.
• Comprehensive health insurance.
• Retirement savings plan.
• Paid time off and holidays.
• Opportunities for professional growth and advancement.

Conclusion:

If you are a motivated and experienced healthcare professional looking to make a difference in the lives of our members, we encourage you to apply for the Senior Specialist, Quality Interventions / QI Compliance role. With your expertise and passion for quality improvement, you will play a critical role in helping us achieve our mission of providing high-quality healthcare services to our members. Apply now and join our team of dedicated professionals who are committed to excellence and quality.

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