Specialist, Quality Interventions/QI Compliance- Remote
Job DescriptionJOB DESCRIPTIONJob SummaryMolina'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.KNOWLEDGE/SKILLS/ABILITIESThe Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.
- 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.
- 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).
- Certified Professional in Health Quality (CPHQ)
- Nursing License (RN may be preferred for specific roles)
- Certified HEDIS Compliance Auditor (CHCA)