Edinburg, TX, 78540, USA
9 days ago
Specialist, Quality Interventions/QI Compliance (Remote in South TX)
**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. **Candidates with experience in a Quality/HEDIS/Clinical setting will receive first consideration. Please identify that experience on your resume.** **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 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. **JOB QUALIFICATIONS** **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). **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. \#PJQA \#LI-AC1 Pay Range: $19.64 - $42.55 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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