The Director serves as the Quality Improvement leader for the State Health Plan and leads programs involving HEDIS, NCQA accreditation, STAR ratings, risk scores for Medicare and Medicaid, CAHPS, HOS, Rx adherence, and state requested reports and projects.
This is a regional position that covers the following states: California, Utah, Idaho, and Washington. 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.
What you will do:
• Leads the development, implementation and management of Quality Improvement initiatives within the health plan.
• Collaborates with health plan Chief Medical Officer in overseeing medical service delivery and quality of care for health plan members.
• Support provision of high quality clinical care by building strategic relationships with health care providers.
• Support maintenance of marketable, high quality, cost effective provider networks.
• Coordinates, directs, and manages the activities of the department and the quality management program.
• Responsible for the analysis of the quality of member care, both individual and systematic, received and for the development of plans and programs to support continuous quality improvement.
• Establishes strategic plans, policies, and procedures to ensure quality programs are consistent with overall MHI quality strategies.
• Responsible for the investigation and resolution of all quality of care grievances and critical incidents, if applicable to the State Health Plan.
• Establishes and coordinates the committees and sub-committees of the department that report to national committees and / or to the State Health Plan Board of Directors.
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.
Required Education Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration 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 • Minimum 3 years people management experience • Operational knowledge and experience with Excel and Visio (flow chart equivalent). • NCQA Accreditation experience.
Preferred Experience, 10+ years, including: • HEDIS reporting or collection experience • CAHPS improvement experience • State QI experience • 3 years experience in Reporting & Analytics
Preferred License, Certification, Association • Certified Professional in Health Quality (CPHQ) • Nursing License • Certified HEDIS Compliance Auditor (CHCA)
Telecommuting is allowed.
Internal Number: 1800287
About Molina Healthcare
Molina Healthcare is a managed care company headquartered in Long Beach, California, United States with headquarter locations in multiple states nationwide, along with remote employment opportunities. The company provides health insurance to individuals through government programs such as Medicaid and Medicare in addition to a plan on the open Marketplace/Exchange. Our mission is to provide quality health care to people receiving government assistance.
Molina Health Plans
Medicaid Molina Healthcare contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP). Molina Healthcare offers Medicaid plans in California, Florida, Illinois, Michigan, Mississippi, Ohio, Puerto Rico, New Mexico, New York, South Carolina, Texas, Utah, Washington and Wisconsin.
Molina Healthcare offers Medicare Advantage plans designed to meet the needs of individuals with Medicare or both Medicaid and Medicare coverage. Molina Medicare plans offer comprehensive, quality benefits ...and programs including access to a large selection of doctors, hospitals and other health care providers at little or no out-of-pocket cost.
Integrated Medicaid/Medicare (Duals)
Molina Healthcare has been selected for several duals demonstration projects as part of a member-centered health care approach for people who are eligible for both Medicaid and Medicare. Molina has been working with these members through our Medicaid and Medicare health plans for many years, and this experience will help us provide these members with high quality care that meets their unique needs.
Molina Healthcare offers Marketplace (known as Exchange in some states) plans in many of the states where we offer Medicaid health plans. Our plans allow our Medicaid members to stay with their providers as they transition between Medicaid and the Marketplace. Additionally, they remove financial barriers to quality care and keep members' out-of-pocket expenses to a minimum.