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 health plan quality/HEDIS is important for this position.  Please make sure your experience in quality/HEDIS is included on your resume.  

KNOWLEDGE/SKILLS/ABILITIES

The Specialist, Provider Quality contributes to one or more of these quality improvement/risk adjustment functions:

Implements key quality and population health strategies and risk adjustment, alongside providers and with direction from the Mgr., Provider Quality and Practice Transformation and Health Plan Leadership, to engage and empower members and impact health outcomes; may include initiation and management of provider interventions (e.g., removing barriers to care.) Helps practices to identify areas of need and helps with efficiency measures to improve availability, through sharing of scorecards, delivering gaps-in-care information and risk reports, sharing of satisfaction results as applicable, and delivering other critical operational and efficiency reports. Coaches practices on how to improve quality and progression toward meeting value-based purchasing goals and works with Health Plan Leadership and Network to assess provider readiness for higher levels on the value-based purchasing continuum. Collaborates with strategic practices and provider sites, including primary care providers and specialists, to identify potential utilization trends and compliance with appointment timeliness standards. Facilitates provider engagement meetings, including meeting agendas, minutes, handouts, and monitoring action items to completion.  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. Creates, manages, and/or compiles the required documentation to maintain critical quality improvement, risk adjustment and population health management functions. Leads quality improvement activities and risk adjustment accuracy 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 Manage any gaps in processes that may require remediation. Completes 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, and/or risk adjustment 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

 

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.