Quality Improvement Specialist

2 days ago

Washington, Washington, D.C., United States Molina Healthcare Full time

Job Summary

Molina Healthcare is seeking a highly skilled Quality Improvement Specialist to join our team. As a key member of our Quality Improvement function, you will oversee, plan, and implement new and existing healthcare quality improvement initiatives and education programs. Your expertise will ensure the 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

  • 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

  • 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

  • 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)

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

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