[Hiring] Program Director, Quality Improvement @Molina Healthcare

Role Description

Provides deep subject matter expertise and leadership for quality improvement (QI) activities. Responsible for new and existing health care 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 National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state QI compliance activities.

• Leads quality programs/projects in one or more of the following critical QI functional areas:
  • Healthcare Effectiveness Data and Information Set (HEDIS) performance measurement
  • Quality reporting
  • Oversight of automated quality software tools and processes
  • Clinical quality interventions
  • Implementation and monitoring of the success of QI activities
  • QI compliance
• Serves as a quality improvement (QI) subject matter expert and leads quality programs to meet critical quality needs; advises senior leaders and other functions and departments on quality strategies and initiatives.
• In collaboration with senior quality leadership, manages QI programs and interventions.
• Collaborates and facilitates QI activities in collaboration with corporate functions and state health plans.
• Leads corporate quality initiatives - ensures timely follow-up, tracking and communications with applicable stakeholders.
• Communicates with and escalates gaps and barriers in QI 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 QI programs.
• Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll-out).
• Collaborates cross-functionally to identify areas and strategies for improved reporting and use of quality reporting tools.
• Leads key clinical intervention activities including implementation of national and state-based quality interventions.
• Facilitates and builds high-quality clinical care/services through relationships with key departments.
• Leads Healthcare Effectiveness Data Information Set (HEDIS) performance measurement programs - leveraging knowledge, skills and technical expertise in performance measurement, data collection and reporting.
• Provides training and support to new and existing quality team members.

Qualifications

• At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Deep knowledge of the quality discipline, including metrics and performance standards.
• Advanced knowledge and understanding of HEDIS/NCQA, including NCQA accreditation experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Medicare Stars program experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• State quality improvement (QI) experience.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Experience in managing provider engagement activities including contract development for quality performance standards.
• Deep Stars improvement, reporting and analytics experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Knowledge of Health Outcomes Survey (HOS) and pay for performance (P4P) models.
• Health care information systems experience.
• Experience in a quality leadership role with a managed care payer with experience in all lines of business (Medicaid, Medicare, and/or Marketplace).
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.

Benefits

• Molina Healthcare offers a competitive benefits and compensation package.
• Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.