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Director, Health Plan Quality Improvement

Oak Brook, Illinois Job ID 2002212
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Job Description

Job Summary
Serves as a leader of health plan Quality strategy and activities, including but not limited to leadership and primary Molina interface with state agencies, leadership of local Quality committees and oversight of intervention activities intended to improve quality measures and outcomes. The Quality Director will collaborate with MHI Quality leaders to conduct data collection, reporting and monitoring for key Quality performance measurement activities. The Quality leader will coordinate with and receive direction from MHI Quality leaders on the implementation of NCQA accreditation surveys and federal QI compliance activities. The Quality Director will be responsible for Medicare Stars strategies and performance improvement. If appropriate, based on volume, the Quality Director will manage Critical Incidents (CIs)and Potential Quality of Care (PQOC) issues locally.

The Director , Quality is responsible for leading health plan Quality strategy and activities, and acting as the Quality subject matter expert for the health plan. Key activities include:
• Serving as the primary contact to State agencies for all Quality matters;
• Leading the local Quality committees
• Preparing, in collaboration and support with MHI Quality, required documentation for state Performance Improvement Projects. This documentation will utilize standard templates and forms to the greatest extent possible.
• Designing, implementing, monitoring and analyzing the effectiveness of a comprehensive Quality intervention strategy and facilitating stakeholder input and strategic direction from the interventions Joint Operations Committee;
• Collaborating with the national, regional and state analytics and strategic teams to develop, present and evaluate
intervention strategies
• Collaborating with MHI Quality for accreditation activities. Accreditation activities will be led primarily by MHI Quality and Director will support those activities with local resources and leadership.
• Planning and implementing evidence-based quality intervention strategies and initiatives that meet state and federal intervention rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina strategic plans;
• Serving as operations and implementation lead for Molina plan quality improvement activities using a defined
roadmap, timeline and key performance indicators.
• Communicating with the Plan President, Molina Plan Senior Leadership Team, Chief Medical Officer,
national intervention collaborative analytics and strategic teams about key deliverables, timelines,
barriers and escalated issues that need immediate attention.
• Communicating with Plan Network leadership to establish QI benchmarks and requirements for VBC contracts.
• Responsible for developing the local Medicare Stars work plan and executing on interventions that will improve CAHPS, HEDIS and HOS scores. Also responsible for monitoring Part D and Operational health insurance metrics and coordinating with centralized teams to improve these metrics.
• Responsible for managing MMP quality withhold revenue in MMP State of Illinois. Candidate will develop interventions and a local strategy to improve withhold revenue earned to meet or exceed budgeted goals.
• Collaborates with and is supported by MHI quality analytics for broad-based quality data analytics. Oversees efforts to develop broad-based quality data analytics to support ongoing, real-time, local VBC contract requirements using both MHI and local resources
• Relies on and collaborates with MHI HEDIS Operations to do majority of HEDIS abstractions. Oversees local resources to facilitate local abstraction for required VBC customized reports to meet VBC network contract obligations not supported by the national MHI team.
• Presenting summaries, key takeaways and action steps about Molina quality strategy to national, regional and plan meetings (internal and external). Demonstrates ability to lead and influence cross-functional teams that oversee implementation of quality interventions. Possesses a strong knowledge in quality in order to implement effective interventions that drive change. Functions as key lead for interventions including qualitative analysis, reporting and development of program materials, templates or policies.
• Maintains strong knowledge of and ability to inspire and work directly with external providers to advance Molina's Value-based quality initiatives. Maintains advanced ability to collaborate and educate network providers to develop effective practice-based quality improvements. Serves as a member of the State's Provider Engagement team for large, contracted, value-based provider systems.
• Attending State and regional Quality Improvement and/or Board of Directors Meetings and representing the Health Plan.
• Representing Molina in external forums, presenting Molina's quality results, and serving as the external quality expert and emissary in statewide conferences and collaborative.
• Director will lead Critical Incident and Potential Quality of Care (PQOC) investigation and reporting if volume is sufficient to staff locally.


Job Qualifications

Required Education
Master's Degree or equivalent. Deep knowledge of Quality Discipline including metrics and performance standards. Project management experience, in a managed healthcare setting is important skill set.

Required Experience:
• 3+ years in health plan Quality Improvement and HEDIS operations.
 3+ years in a Quality leadership role with a managed care organization.
• NCQA experience.
• Population Health Management experience.
Project management experience. 
• Experience developing performance measures that support business objectives.

Preferred Experience:
• HEDIS reporting or collection experience.
• State QI experience.
• Experience in Reporting & Analytics.
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
• Knowledge of NCQA Accreditation, pay for performance, basic experience with other quality metrics like PQI (hospital), NQF-sanctioned measurement.

• CAHPS improvement experience

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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  • Quality Assurance, Oak Brook, Illinois, United StatesRemove