Molina Healthcare Specialist, Quality Interventions (Provider Engagement) in Troy, Michigan
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.
Knowledge/Skills/Abilities The 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 in order 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. This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location. This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.
Required Education Bachelor's Degree or equivalent combination of education and work experience. Required Experience • 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). Required License, Certification, Association N/A Preferred Education Preferred field: Clinical Quality, Public Health or Healthcare. Preferred Experience 1 year of experience in Medicare and in Medicaid. Preferred License, Certification, Association • Certified Professional in Health Quality (CPHQ) • Nursing License (RN may be preferred for specific roles) • 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.
Job: *Health Plans
Organization: *Health Plans
Title: Specialist, Quality Interventions (Provider Engagement)
Requisition ID: 1802846