[Hiring] Sr Quality Improvement/HEDIS Specialist @Molina Healthcare

Role Description

Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health Plan Community Interventions team. This role is remote; however, candidates must live in Ohio. This role is laser-focused on Quality Improvement using QI Science and will be assigned a primary population stream to support improvement work for Medicare Stars Measures.

• Using the specific models for improvement required by the state of Ohio
• Experience with a formal model like IHI, Lean, or Six Sigma (Green or Yellow Belt Improvement)
• Power BI is helpful but expert level is not required
• Familiarity with Medicare (Ideally the Duals population)
• Familiarity with QI Science, Health Equity, Population Health, Health Management

This role also provides senior-level support for clinical quality member intervention activities, responsible for developing and implementing new and existing member intervention initiatives across all lines of business (Medicare, Marketplace, Medicaid, etc.). Executes health plan member and community quality-focused interventions and programs in accordance with established program standards and federal/state/National Committee for Quality Assurance (NCQA) regulations.

• Conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.
• Implements evidence-based and data-informed key member intervention strategies including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
• Monitors and ensures that key member intervention activities are completed on time and accurately, and presents results to key departmental management and other applicable Molina departments.
• Writes narrative reports to interpret regulatory specifications, explains programs and results of programs, and documents findings and limitations of department interventions.
• Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
• Participates in quality improvement (QI) activities, meetings, and discussions with and between other departments within the organization.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs).
• Evaluates quality project/program activities and results to identify opportunities for improvement.
• Raises gaps in processes that may require remediation to quality leadership.
• Provides support for quality-related projects.
• Provides training and support to new and existing quality member interventions team members.
• Demonstrates flexibility when it comes to change management and maintains a positive outlook.
• This position may require same-day out-of-office travel 0 - 80% of the time, depending upon state-specific needs.
• This position may require multi-day overnight travel on occasion, depending upon state-specific needs.

Qualifications

• At least 3 years of experience in health care, and at least 2 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
• Demonstrated solid business writing experience.
• Proficiency with data analysis, manipulation, and interpretation.
• Intermediate knowledge and understanding of HEDIS and NCQA.
• Critical-thinking, problem-solving, and analytical skills.
• Attention to detail and organizational skills.
• Ability to navigate change with flexibility and a positive outlook.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Experience with data reporting, analysis, and interpretation.
• Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs.
• 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.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.