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Sr Specialist, Quality Interventions/QI Compliance (Remote in MS) - Military Veterans

at Molina Healthcare

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 will require 50%+ travel around southern Mississippi.

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: $44,937 - $97,362.61 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Hattiesburg, MS

Molina Healthcare

Molina believes every person, family and community deserves access to high-quality health care regardless of their situation. Our mission is to deliver effective, reliable and affordable health care to those who need it most. We strive to meet the physical, social and emotional needs of each member and to strengthen the communities we serve. 

We do this by offering a holistic, community-based approach designed specifically to meet the individual needs of our members. 

What started in 1980 as one clinic in Long Beach, aimed at addressing the disparities in access to quality health care, has grown into 19 health plans across the country. For over 40-years we’ve been improving the lives of our 5.1 million members across the country by pioneering health care services exclusively for those with government-sponsored health care. 

As our membership has grown over the years, so has our commitment to the communities we serve. In 2020, we launched the MolinaCares Accord, which makes substantial investments to improve members’ access to health care. 

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