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Sr Specialist, Quality Interventions/QI Compliance (Remote in South Florida)
Molina Healthcare • Remote • Posted 7 days ago
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Remote • Full-time • $44,937-$97,363/yr • Senior Level
Job Highlights
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The Senior Specialist, Quality Interventions / QI Compliance at Molina Healthcare oversees, plans, and implements healthcare quality improvement initiatives and education programs. This role ensures the 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. Candidates with experience in healthcare Quality/HEDIS metrics/Risk Adjustment will receive first consideration.
Responsibilities
- Acts 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.
- Implements key quality strategies, including 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.
- Other tasks, duties, projects, and programs as assigned.
Qualifications
Required
- 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
- 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)
About Molina Healthcare
Molina Healthcare is a Fortune 500 managed care company operating in the United States. They offer Medicaid, Medicare, and Marketplace health plans, focusing on providing affordable, quality healthcare to underserved populations. The company has expanded through acquisitions, such as acquiring Magellan Complete Care to enter the Florida market and enhance their services.
Full Job Description
**JOB DESCRIPTION**
**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.
**Candidates with experience in healthcare Quality/HEDIS metrics/Risk Adjustment will receive first consideration.**
**KNOWLEDGE/SKILLS/ABILITIES**
The Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.
+ Acts 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.
+ 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.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and work experience.
**Required Experience**
+ Min. 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 Education**
Preferred field: Clinical Quality, Public Health or Healthcare.
**Preferred Experience**
+ 1 year of experience in Medicare and in Medicaid.
+ Experience with data reporting, analysis and/or interpretation.
**Preferred License, Certification, Association**
+ 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)
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.
\#PJQA
\#LI-AC1
Pay Range: $44,936.59 - $97,362.61 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**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.
**Candidates with experience in healthcare Quality/HEDIS metrics/Risk Adjustment will receive first consideration.**
**KNOWLEDGE/SKILLS/ABILITIES**
The Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.
+ Acts 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.
+ 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.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and work experience.
**Required Experience**
+ Min. 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 Education**
Preferred field: Clinical Quality, Public Health or Healthcare.
**Preferred Experience**
+ 1 year of experience in Medicare and in Medicaid.
+ Experience with data reporting, analysis and/or interpretation.
**Preferred License, Certification, Association**
+ 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)
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.
\#PJQA
\#LI-AC1
Pay Range: $44,936.59 - $97,362.61 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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