Director, National Quality Interventions (Member Programs)
New
M
Molina HealthcareHealthcare quality
United StatesFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- 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 of management/leadership experience.
- Required Skills
- Project ManagementMicrosoft Power BIMicrosoft Excel
Requirements
- At least 8 years of healthcare experience, including at least 5 years in health plan quality improvement or compliance, or equivalent relevant education and experience.
- At least 3 years of management or leadership experience.
- Deep knowledge of quality metrics and performance standards.
- Advanced knowledge of HEDIS and NCQA, including NCQA accreditation experience.
- Experience improving CAHPS performance and collecting or reporting HEDIS data.
- Experience with government-sponsored programs, including Medicaid, Medicare, or Marketplace, and Medicare Stars.
- Experience developing performance measures that support business objectives and state quality improvement initiatives.
- Proficiency in data analysis, manipulation, interpretation, reporting, and data-driven decision-making.
- Project management experience and ability to implement process improvement initiatives and drive change.
- Strong business writing, verbal and written communication, strategic thinking, critical thinking, problem-solving, and organizational skills.
- Proficiency with Microsoft Office, including Excel, and applicable software programs.
Responsibilities
- Plan and implement national and state quality interventions aligned with state and federal rules and quality best practices.
- Develop targeted HEDIS performance improvement interventions, including member and provider outreach.
- Lead quality intervention operations using defined roadmaps, timelines, and key performance indicators.
- Coordinate quality deliverables, timelines, barriers, and escalated issues with senior leaders and analytics and strategy teams.
- Report intervention strategies, findings, and action steps at national and health plan meetings.
- Coordinate health plan resources and training, and address barriers to quality goals and timelines.
- Develop medical record pursuit strategies and oversee record operations with the HEDIS operations team.
- Build relationships with healthcare providers and support clinical care, medical care management, disease management, and care coordination activities.
- Audit corporate and health plan programs and recommend system-wide process improvements.
- Hire, train, mentor, and manage team performance against departmental goals.
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