Program Director, Quality Improvement (Remote)

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. KNOWLEDGE/SKILLS/ABILITIES The Program Director is a key Quality Improvement (QI) leader within the organization, empowered to advise senior management and other departments on Quality strategies and initiatives. This is an individual contributor role that leads programs/projects in one or more of the following critical QI functional areas: HEDIS Performance Measurement, which conducts data collection, reporting and monitoring for key performance measurement activities; Quality Reporting, which develops reports to meet QI requirements and oversees the use of automated software tools and processes; Clinical Quality Interventions, which develops, implements and monitors the success of QI activities; and QI Compliance, which provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities. • Serves as a QI subject matter expert and leads programs to meet critical Quality needs. • Manages QI programs with oversight from the Director, AVP and VP as needed. • Collaborates and facilitates activities with other units at Corporate and within Molina State Plans. • Provides direction for QI program activities with department leadership including leading Corporate quality initiatives that require timely follow-up, tracking and communication on an on-going basis. • Communicates with and escalates gaps and barriers in implementation and compliance to department leadership, including proposed resolution. • Monitors and tracks key quality indicators, programs, and initiatives to reflect the value and effectiveness of the quality program. • Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll out). • Collaborates with Molina State Plans to identify areas and strategies for improved reporting and use of reporting tools. • Leads key Clinical Intervention activities including implementation of national and state-based Quality interventions, meeting state and federal intervention rules and aligned with best practices identified in literature and within Molina plans. • Works with Molina Plans and QI leadership to ensure that interventions are communicated, monitored, and reported on a timely basis to demonstrate program effectiveness. • Facilitates and builds high quality clinical care/services through relationships with key departments within Molina and at Molina plans. • Leads HEDIS Performance Measurement programs using knowledge, skills and technical expertise in performance measurement, data collection and reporting. • Maintains confidentiality and complies with the Health Insurance Portability and Accountability Act (HIPAA). JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and work experience. Required Experience • Minimum of 7+ years relevant experience, including at least 5 years in health plan quality improvement. • Demonstrated knowledge of and experience with HEDIS programs. • 2 years Medicaid experience • 2 years Medicare experience • 3 years management experience • Operational knowledge and experience with Excel and Visio (flow chart equivalent). • Proficiency with data manipulation and interpretation. • NCQA Accreditation experience. Preferred Education Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration. Preferred Experience • HEDIS reporting or collection experience • CAHPS improvement experience • State QI experience • 3 years' experience in Reporting & Analytics • 3 years' experience in Health Care Industry • Quality program leadership and direction 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. Apply tot his job Apply To this Job