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Sr Specialist, Quality Interventions - Process Improvement

Columbus, Ohio Job ID 1902457
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Job 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.

The Senior Analyst, Quality Improvement (QI) Interventions/Compliance contributes to either or both of these critical Quality functions: Clinical Quality Interventions and Quality Improvement Compliance.
• Acts as a lead analyst to provide project-, program-, and / or initiative-related direction and guidance for other analysts within the department and/or collaboratively with other departments.
• Collaborates with other Quality Improvement staff to analyze and report the results of quality improvement studies, initiatives and / or projects to monitor, evaluate and / or continuously improve the quality of healthcare services provided to Molina members.
• Evaluates the collection, evaluation and / or dissemination of quality improvement data for quality initiatives, studies and / or projects to comply with regulatory requirements and / or accreditation standards.
• Writes, prepares, and / or presents reports and analyses to evaluate performance improvement using a variety of sources, including, but not limited to: internal quantitative data; external industry data; survey data; input from members, providers and / or other key stakeholders; input from Molina employees and senior leaders, etc.
• Produces reports and analyses that show graphically the results of QI projects and collaborates as needed to ensure reports meet required timelines, business needs, and NCQA or other regulatory requirements.
• Performs qualitative and / or quantitative analyses to identify important and urgent concerns; develops improvement plans and / or measurements to assess impact of actions.
• Participates in NCQA accreditation and regulatory audit preparedness activities including preparing reports, narratives, graphs, charts, etc., updating policies and procedures, and / or participating in program committees.
• May participate in other activities such as, but not limited to: the analysis of quality of care issues and serious reportable adverse conditions, the analysis of credentialing files, the analysis of quality metric data, including, but not limited to, HEDIS, STARS, etc., the analysis of medical records data, etc.


Job Qualifications

Required Education
Bachelor's Degree or equivalent combination of education and work experience.
Required Experience
• Min. 3 years experience in healthcare with 2 years experience in health plan quality improvement, managed care or equivalent experience.
• Demonstrated solid business writing experience.
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).
Required License, Certification, Association
Preferred Education
Master's Degree or higher in a clinical field, Public Health or Healthcare.

Preferred Experience
• 1 year of experience in Medicare and in Medicaid.
• HEDIS reporting or collection experience.
• Experience developing and / or analyzing performance measures that support business objectives.
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.


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