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Sr Specialist, Quality Interventions/QI Compliance- NCQA Accreditation (Remote in Nevada)

Company: Molina Healthcare
Location: Sparks
Posted on: May 7, 2024

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 focuses on Quality Compliance for a health plan and requires experience within that space. -
The Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

  • Brings extensive experience in health plan quality compliance. - - -
  • Utilizes a strong background in NCQA accreditation surveys.
  • Has a strong focus on MCO Quality regulatory reporting. -
  • 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.

    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.
    • Health Plan Quality Improvement Compliance.
    • NCQA accreditation 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

      • Project Management in healthcare or for a health plan. -
      • 1 year of experience in Medicare and in Medicaid.
      • Experience with data reporting, analysis and/or interpretation.

        Preferred License, Certification, Association

        • PMP Certification
        • 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.
          #LI-AC1 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, Sparks , Sr Specialist, Quality Interventions/QI Compliance- NCQA Accreditation (Remote in Nevada), Other , Sparks, Nevada

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