Supervisor, Quality of Care at Molina Healthcare

Remote
Molina Healthcare

SUPERVISOR, QUALITY OF CARE – RN (REMOTE)

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.

Knowledge/Skills/Abilities

  • 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.

Required Education

  • Bachelor’s Degree or equivalent combination of education or experience.

Required 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.

Preferred Education

  • Advanced degree in Clinical Quality, Public Health or Healthcare.

Preferred Experience

  • 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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