Experienced Quality Improvement Specialist - Healthcare Quality Interventions and Compliance Expert

Introduction to Molina Healthcare

Molina Healthcare is a leading organization in the healthcare industry, dedicated to providing high-quality services to its members. Our mission is to improve the health and well-being of our members by delivering exceptional healthcare solutions. We are committed to fostering a culture of excellence, innovation, and collaboration, and we are seeking a talented and experienced Specialist, Quality Interventions/QI Compliance to join our team.

Job Summary

The Specialist, Quality Interventions/QI Compliance will play a critical role in overseeing, planning, and implementing new and existing healthcare quality improvement initiatives and education programs. This position requires a strong and diverse skillset in relevant areas, including quality improvement, compliance, and project management. The successful candidate will have the opportunity to work remotely and contribute to the development and implementation of quality improvement strategies that drive success and improve healthcare outcomes.

Key Responsibilities

• Implement key quality strategies, including initiation and management of provider, member, and/or community interventions, preparation for Quality Improvement Compliance surveys, and other federal and state required quality activities
• Monitor and ensure that key quality activities are completed on time and accurately, presenting results to key departmental management and other Molina departments as needed
• Write narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions
• Create, manage, and/or compile the required documentation to maintain critical quality improvement functions
• Lead quality improvement activities, meetings, and discussions with and between other departments within the organization
• Evaluate project/program activities and results to identify opportunities for improvement
• Surface to Manager and Director any gaps in processes that may require remediation
• Perform other tasks, duties, projects, and programs as assigned

Essential Qualifications

To be successful in this role, the candidate will require:

• Bachelor's Degree or equivalent combination of education and work experience
• Minimum 3 years' experience in healthcare with 1 year 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)

Preferred Qualifications

Preferred candidates will have:

• Preferred field: Clinical Quality, Public Health, or Healthcare
• 1 year of experience in Medicare and in Medicaid
• Certified Professional in Health Quality (CPHQ)
• Nursing License (RN may be preferred for specific roles)
• Certified HEDIS Compliance Auditor (CHCA)

Skills and Competencies

The successful candidate will possess:

• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong project management skills, with the ability to prioritize tasks and manage multiple projects simultaneously
• Knowledge of quality improvement principles and methodologies
• Experience with data analysis and reporting

Career Growth Opportunities and Learning Benefits