Director, Health Plan Quality Improvement, Long Beach, CA
The Director serves as the Quality Improvement leader for the State Health Plan and leads programs involving HEDIS, NCQA accreditation, STAR ratings, risk scores for Medicare and Medicaid, CAHPS, HOS, Rx adherence, and state requested reports and projects.
This is a regional position that covers the following states: California, Utah, Idaho, and Washington.
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.
What you will do:
- Leads the development, implementation and management of Quality Improvement initiatives within the health plan.
- Collaborates with health plan Chief Medical Officer in overseeing medical service delivery and quality of care for health plan members.
- Support provision of high quality clinical care by building strategic relationships with health care providers.
- Support maintenance of marketable, high quality, cost effective provider networks.
- Coordinates, directs, and manages the activities of the department and the quality management program.
- Responsible for the analysis of the quality of member care, both individual and systematic, received and for the development of plans and programs to support continuous quality improvement.
- Establishes strategic plans, policies, and procedures to ensure quality programs are consistent with overall MHI quality strategies.
- Responsible for the investigation and resolution of all quality of care grievances and critical incidents, if applicable to the State Health Plan.
- Establishes and coordinates the committees and sub-committees of the department that report to national committees and / or to the State Health Plan Board of Directors.
Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration or equivalent combination of education and work 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
- Minimum 3 years people management experience
- Operational knowledge and experience with Excel and Visio (flow chart equivalent).
- NCQA Accreditation experience.
10+ years, including:
- HEDIS reporting or collection experience
- CAHPS improvement experience
- State QI experience
- 3 years experience in Reporting & Analytics
Preferred License, Certification, Association
- Certified Professional in Health Quality (CPHQ)
- Nursing License
- 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.