Supervisor, Quality of Care at Molina Healthcare
SUPERVISOR, QUALITY OF CARE – RN (REMOTE)
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.
- The Supervisor, Quality Interventions/Compliance supervises staff who contribute to one or more of these quality improvement functions: Quality Interventions and / or QI Compliance.
- Supervises other staff who have the responsibility for the implementation of key quality improvement (QI) 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.
- Implements Molina Healthcare goals and oversees local processes for quality interventions, accreditation, State compliance activities, CMS quality activities and/or other QI interventions or compliance duties as required.
- Defines and documents QI Interventions and/or Compliance policies and procedures for the work team.
- Identifies and reports gaps in processes that may result in gaps in member care or satisfaction.
- Works to ensure that any differences in health plan QI processes from the standard Corporate model have sufficient justification based on market/business needs or State-specific regulations.
- Provides and oversees reporting requirements to regulatory agencies.
- Effectively manages internal and external vendor communications by collaborating and disseminating reports, defining program descriptions, and sharing analytical findings.
- Implements, monitors, and evaluates QI interventions and/or compliance activities in consultation with the Manager, Director, and / or AVP of the department.
- Works collaboratively with other Molina Health Plan and/or Corporate departments as needed to accomplish QI activities and to ensure that all tasks are accomplished timely and accurately.
- Bachelor’s Degree or equivalent combination of education or experience.
- Min. 4 years experience in healthcare with minimum 2 years experience in health plan quality improvement, managed care or equivalent experience.
- Demonstrated solid business writing experience.
- Advanced degree in Clinical Quality, Public Health or Healthcare.
- HEDIS reporting or collection
- CAHPS improvement experience
- State QI experience.
- Provider credentialing; PQOC review
- Medicaid experience.
- Supervisory experience.
- Project management and team building experience.
Preferred License, Certification, Association
- Certified Professional in Health Quality (CPHQ)
- Nursing License (RN may be preferred for specific roles)
- Certified HEDIS Compliance Auditor (CHCA)
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