Senior Specialist, HEDIS Quality Interventions - Kentucky Area

Molina Healthcare - Utica, KY 42376
November 15, 2020
Full Time
Job DescriptionJob SummaryMolina'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.Knowledge/Skills/AbilitiesThe Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.* Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.* Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.* Monitors and ensures that key quality activities are completed on time and accurately in order 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.* 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.Job QualificationsRequired EducationBachelor's Degree or equivalent combination of education and work experience.Required Experience* Min. 3 years experience in healthcare with minimum 2 years 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).Required License, Certification, AssociationN/APreferred EducationPreferred field: Clinical Quality, Public Health or Healthcare.Preferred Experience1 year of experience in Medicare and in Medicaid.Experience with data reporting, analysis and/or interpretation.Preferred License, Certification, Association* Certified Professional in Health Quality (CPHQ)* Nursing License (RN may be preferred for specific roles)* 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.
Location/Region: Utica, KY (42376)