Quality Improvement Specialist

4 days ago


South Florida Terraces, United States Molina Healthcare Full time
Job Overview

Molina Healthcare seeks a highly skilled Quality Improvement Specialist to oversee, plan, and implement new and existing healthcare quality improvement initiatives and education programs. The ideal candidate will ensure maintenance of programs for members in accordance with prescribed quality standards, conduct data collection, reporting, and monitoring for key performance measurement activities, and provide direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

Key Responsibilities

  • Provide project-, program-, and/or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.
  • 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 to present 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.

Requirements

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

Preferred Qualifications

  • 1 year of experience in Medicare and in Medicaid.
  • Experience with data reporting, analysis, and/or interpretation.
  • Active, unrestricted Certified Professional in Health Quality (CPHQ)
  • Active, unrestricted Nursing License (RN may be preferred for specific roles)
  • Active, unrestricted Certified HEDIS Compliance Auditor (CHCA)

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $44,936.59 - $97,362.61 / ANNUAL



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