Quality Improvement Supervisor
2 weeks ago
POSITION SUMMARY
The Quality Improvement Supervisor at Molina Healthcare plays a pivotal role in overseeing, planning, and executing both new and ongoing healthcare quality enhancement initiatives and educational programs. This position ensures the adherence to established quality standards while managing programs for members. Responsibilities include data collection, reporting, and monitoring key performance metrics, along with directing NCQA accreditation surveys and compliance activities at both federal and state levels.
KEY RESPONSIBILITIES
The Supervisor of Quality Interventions/Compliance is responsible for leading a team that contributes to various quality improvement functions, including:
- Overseeing staff tasked with implementing essential quality improvement strategies, which may involve managing provider, member, and community interventions aimed at eliminating barriers to care.
- Preparing for Quality Improvement Compliance surveys and ensuring compliance with federal and state quality mandates.
- Establishing and documenting policies and procedures related to Quality Interventions and Compliance for the team.
- Identifying and reporting process gaps that could impact member care or satisfaction.
- Ensuring that any deviations from the standard Corporate model in health plan QI processes are justified based on market needs or state-specific regulations.
- Managing reporting obligations to regulatory bodies.
- Facilitating effective communication with internal and external vendors by sharing reports, defining program descriptions, and presenting analytical insights.
- Implementing, monitoring, and evaluating quality improvement interventions and compliance activities in collaboration with department leadership.
- Working in partnership with other Molina Health Plan and Corporate departments to ensure timely and accurate completion of QI activities.
QUALIFICATIONS
Education Requirements
- Registered Nursing License.
- Minimum of 2 years in a leadership role.
- At least 5-7 years of clinical experience.
- Bachelor's Degree or an equivalent combination of education and experience.
Experience Requirements
- A minimum of 4 years in healthcare, with at least 2 years in health plan quality improvement, managed care, or a related field.
- Proven experience in business writing.
- Operational proficiency with Excel and Visio (or equivalent flowchart tools).
Preferred Qualifications
Education: Advanced degree in Clinical Quality, Public Health, or Healthcare.
Experience:
- Experience with HEDIS reporting or data collection.
- Background in CAHPS improvement initiatives.
- Experience with state-level quality improvement.
- Knowledge of provider credentialing and PQOC review processes.
- Familiarity with Medicaid operations.
- Previous supervisory experience.
- Project management and team-building skills.
Certifications:
- Certified Professional in Health Quality (CPHQ).
- Nursing License (RN may be preferred for specific roles).
- Certified HEDIS Compliance Auditor (CHCA).
Molina Healthcare is committed to providing a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.
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