Sr Specialist, Quality Interventions/QI Compliance/Member Intervention - (Remote in New Mexico)

Company: Molina Healthcare
Location: Albuquerque
Posted on: April 23, 2024

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. -This position could require very limited travel to health fairs and community events. -
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.

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• 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
  
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  • 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
    
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    • 1 year of experience in Medicare and in Medicaid.
      
    • Experience with data reporting, analysis and/or interpretation.
      
      Preferred License, Certification, Association
      
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      • 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)
        
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        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: $44,936.59 - $97,362.61 / ANNUAL
        *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Keywords: Molina Healthcare, Rio Rancho , Sr Specialist, Quality Interventions/QI Compliance/Member Intervention - (Remote in New Mexico), Other , Albuquerque, New Mexico