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Program Director, Quality Improvement (Remote)
Molina Healthcare Ann Arbor, Michigan; Phoenix, Arizona; San Antonio, Texas; Cleveland, Ohio; Syracuse, New York; Mesa, Arizona; Louisville, Kentucky; Rio Rancho, New Mexico; Iowa; Fort Worth, Texas; Columbus, Ohio; Owensboro, Kentucky; Savannah, Georgia; Detroit, Michigan; Yonkers, New York; Layton, Utah; Dallas, Texas; New Mexico; Des Moines, Iowa; Milwaukee, Wisconsin; St. Petersburg, Florida; Santa Fe, New Mexico; Las Cruces, New Mexico; Chandler, Arizona; Tampa, Florida; Kenosha, Wisconsin; Georgia; Kentucky; Utah; Roswell, New Mexico; Tucson, Arizona; Vancouver, Washington; Spokane, Washington; Boise, Idaho; Orlando, Florida; Atlanta, Georgia; Covington, Kentucky; Bowling Green, Kentucky; Albuquerque, New Mexico; Meridian, Idaho; Texas; Idaho; Macon, Georgia; Kearney, Nebraska; Albany, New York; West Valley City, Utah; Caldwell, Idaho; Miami, Florida; Dayton, Ohio; Orem, Utah; Grand Rapids, Michigan; Nebraska; New York; Grand Island, Nebraska; Bellevue, Washington; Lincoln, Nebraska; Sioux City, Iowa; Racine, Wisconsin; Jacksonville, Florida; Madison, Wisconsin; Buffalo, New York; Salt Lake City, Utah; Warren, Michigan; Austin, Texas; Columbus, Georgia; Augusta, Georgia; Houston, Texas; Everett, Washington; Rochester, New York; Omaha, Nebraska; Davenport, Iowa; Cincinnati, Ohio; Ohio; Michigan; Cedar Rapids, Iowa; Green Bay, Wisconsin; Akron, Ohio; Lexington-Fayette, Kentucky; Sterling Heights, Michigan; Florida; Washington; Wisconsin; Idaho Falls, Idaho; Provo, Utah; Bellevue, Nebraska; Scottsdale, Arizona; Nampa, Idaho; Tacoma, Washington; Iowa City, Iowa Job ID 2032147JOB DESCRIPTION
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 Program Director is a key Quality Improvement (QI) leader within the organization, empowered to advise senior management and other departments on Quality strategies and initiatives. This is an individual contributor role that leads programs/projects in one or more of the following critical QI functional areas: HEDIS Performance Measurement, which conducts data collection, reporting and monitoring for key performance measurement activities; Quality Reporting, which develops reports to meet QI requirements and oversees the use of automated software tools and processes; Clinical Quality Interventions, which develops, implements and monitors the success of QI activities; and QI Compliance, which provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities.
- Serves as a QI subject matter expert and leads programs to meet critical Quality needs.
- Manages QI programs with oversight from the Director, AVP and VP as needed.
- Collaborates and facilitates activities with other units at Corporate and within Molina State Plans.
- Provides direction for QI program activities with department leadership including leading Corporate quality initiatives that require timely follow-up, tracking and communication on an on-going basis.
- Communicates with and escalates gaps and barriers in 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 the quality program.
- Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll out).
- Collaborates with Molina State Plans to identify areas and strategies for improved reporting and use of reporting tools.
- Leads key Clinical Intervention activities including implementation of national and state-based Quality interventions, meeting state and federal intervention rules and aligned with best practices identified in literature and within Molina plans.
- Works with Molina Plans and QI leadership to ensure that interventions are communicated, monitored, and reported on a timely basis to demonstrate program effectiveness.
- Facilitates and builds high quality clinical care/services through relationships with key departments within Molina and at Molina plans.
- Leads HEDIS Performance Measurement programs using knowledge, skills and technical expertise in performance measurement, data collection and reporting.
- Maintains confidentiality and complies with the Health Insurance Portability and Accountability Act (HIPAA).
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and work experience.
Required Experience
- Minimum of 7+ years relevant experience, including at least 5 years in health plan quality improvement.
- Demonstrated knowledge of and experience with HEDIS programs.
- 2 years Medicaid experience
- 2 years Medicare experience
- 3 years management experience
- Operational knowledge and experience with Excel and Visio (flow chart equivalent).
- Proficiency with data manipulation and interpretation.
- NCQA Accreditation experience.
Preferred Education
Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration.
Preferred Experience
- HEDIS reporting or collection experience
- CAHPS improvement experience
- State QI experience
- 3 years’ experience in Reporting & Analytics
- 3 years’ experience in Health Care Industry
- Quality program leadership and direction
Preferred License, Certification, Association
- Certified Professional in Health Quality (CPHQ)
- Nursing License (RN may be preferred for specific roles)
- Certified HEDIS Compliance Auditor (CHCA)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $80,412 - $188,164 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type Full Time Posting Date 07/31/2025Job Alerts
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