Job Summary
The Director, Clinical Data Acquisition is responsible for the implementation, monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment, Risk Adjustment Data Validation, and other state specific audit projects and deliverables. This role also works with the Health Plan quality leads to strategically plan for supplemental data source (SDS) acquisition from providers as well as Electronic Medical Record (EMR) access. This position would oversee management of training for all CDA team members as well as company HEDIS training, onboarding for CDA team members, vendor management for chart collection vendors, invoice efforts, SDS and EMR implementation as well as other project and staffing support management.
Job Duties
Plans and/or implements operational processes for HEDIS operations that meet state and federal reporting requirements/rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina plans. Develops and implements targeted collection of clinical data acquisition related to performance reporting and improvement, including member and provider outreach. Serves as operations subject matter expert and lead for Molina Plan quality improvement HEDIS operations using a defined roadmap, timeline and key performance indicators. Collaborates with the national intervention collaborative analytics and strategic teams to deliver value for both prospective and retrospective programs. Communicates with the Molina Plan Senior Leadership Team, including the Plan President, Chief Medical Officer, national intervention teams and strategic teams about key deliverables, timelines, barriers and escalated issues that need immediate attention. Presents concise summaries, key takeaways and action steps about Molina HEDIS processes, strategy and progress to national, regional and plan meetings. Demonstrates ability to lead and influence cross-functional teams that oversee implementation of quality projects. Possesses a strong knowledge in quality in order to implement effective operations that drive change. Functions as key lead for clinical chart review/abstraction and team management. This includes qualitative analysis, reporting and development of program materials, templates or policies. Maintains productivity reporting, management and coaching. Maintains advanced ability to collaborate and Manage production vendor relationships, including oversight, data driven KPI measurement and performance mitigation strategies.
Job Qualifications
REQUIRED EDUCATION:
Bachelor's Degree in a clinical field, Public Health, Healthcare, or equivalent.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 8+ years’ experience in managed healthcare, including at least 4 years in health plan quality or process improvement or equivalent/related experience.
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).
PREFERRED EXPERIENCE:
• 10+ years’ experience with member/ provider (HEDIS) outreach and/or quality intervention or improvement studies (development, implementation, evaluation) and Director level experience.
• 3-5 years Supervisory experience.
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• Certified HEDIS Compliance Auditor (CHCA)
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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.