Job Description
Job Summary
The Manager, Quality Program Management and Performance oversees and leads activities to maintain compliance with state requirements and federal and/or NCQA quality requirements, as appropriate in collaboration with quality leadership. Manages quality program management activities to ensure compliance with regulatory requirements, including managing staff.
Job Duties
- Oversees and leads activities to maintain compliance with state requirements and federal and/or NCQA quality requirements, as appropriate in collaboration with quality leadership with implementation of Health Plan quality program management and performance activities
- Manages quality program management activities to ensure compliance with regulatory requirements, including managing staff
- Maintains structure and processes for quality program management, including maintenance and modification of quality policies and procedures, management and oversight of committee and workgroup structure and document management, report completion to meet requirements, and tracking of key deliverables
- Prepares written reports and documents that clearly outline the quality program activities and ensure that member and provider feedback is incorporated into quality program management meetings, outcomes from these activities are documented, and continuous quality improvement tools are used to highlight the processes, interventions, and remeasurements are conducted to meet improvement goals
- Maintains ongoing revision of policies and procedures reflective of state requirements (and/or federal and NCQA requirements, as appropriate) for all quality program management functions by overseeing the ongoing incorporation and modification of requirements into state-specific policy addendums
- Manages training and education of quality program management and performance staff about completion of quality program management and performance activities in line with regulatory requirements
- Ensures all quality program management and performance staff are well-versed in the requirements of the quality program and day-to-day work processes to support compliance with state contracts, policies and procedures, and program requirements
- Implements tracking and trending of quality program requirements on an ongoing basis, including operational key performance indicators, process reviews, and gap analyses
- Utilizes proven quality improvement methods, such as the Plan-Do-Study-Act (PDSA) cycle, to facilitate individual, team, and organizational process improvement
- Demonstrates flexibility when it comes to changes and maintains a positive outlook
- Has excellent conflict resolution problem-solving skills
- This position may require same-day out-of-office travel 0 – 50% of the time, depending on the location
- This position may require multiple days out of town overnight travel 0 – 20% of the time, depending upon location
Job Qualifications
REQUIRED QUALIFICATIONS:
- Bachelor’s Degree or equivalent combination of education and work experience
- 5-7 years of experience in healthcare with a minimum of 2 years’ experience in health plan quality management improvement, managed care, or equivalent experience
- Demonstrated solid business writing experience
- Operational knowledge and experience with Excel and Visio (flow chart equivalent)
PREFERRED QUALIFICATIONS:
- Advanced degree in Nursing, Public Health, Health Administration, Social Work, or related field
- HEDIS reporting or collection
- CAHPS improvement experience
- State QI experience
- Medicaid experience
- Supervisory experience
- Project management and team building experience
- 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