JOB DESCRIPTION

Job Summary

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs specific to the Provider Network; ensures maintenance of Provider Quality Improvement programs in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities.

Experience with quality, providers and HEDIS is very important for this position. Please highlight this experience on your resume. 

KNOWLEDGE/SKILLS/ABILITIES

The Specialist, Provider Engagement contributes to one or more of these quality improvements functions:

Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); and other federal and state required quality activities. Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed. Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions. Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions. Leads quality improvement activities, meetings, and discussions with and between other departments within the organization or with and between key provider network partners. Evaluates project/program activities and results to identify opportunities for improvement. Surfaces to Manager and Director any gaps in processes that may require remediation. Other tasks, duties, projects, and programs as assigned. This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location. This position may require multiple day out of town overnight travel approximately on occasion, depending upon location.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

Min. 3 years’ experience in healthcare with 1 year experience in health plan quality improvement (HEDIS), managed care or equivalent experience. Demonstrated solid business writing experience. Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Preferred License, Certification, Association

Certified Professional in Health Quality (CPHQ) Nursing License (RN may be preferred for specific roles) Certified HEDIS Compliance Auditor (CHCA) Experience with EPSDT

 

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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