Director, Health Plan Quality Program Management & Performance (Remote in New York)

Molina Healthcare; New York (NY); Remote; USD 97,000 - 228,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare seeks an experienced leader to direct quality management and performance improvement across the health plan. You will oversee NCQA accreditation activities, implement HEDIS regulations, and guide teams through surveys, audits, and data-driven improvement initiatives.

Responsibilities include policy management, reporting, and cross-functional collaboration with analytics and leadership to drive KPIs and outcomes. Travel requirements may apply based on state needs.

Qualifications

• 8+ years in health care with 5+ years in health plan quality improvement.
• Minimum 3 years of management/leadership experience.
• Advanced knowledge of HEDIS/NCQA.
• CAHPS improvement experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Strong writing, data-driven decision making and analytical skills.
• Proficient in Excel and analytics software.

Responsibilities

• Directs team for quality program management strategies, audits and surveys.
• Oversees health plan quality program management in NCQA-compliant ways.
• Represents senior leadership at national/regional meetings as SME.
• Collaborates with analytics to evaluate QPMP activities.
• Maintains policies, procedures, governance and document management.
• Prepares reports outlining quality program activities and outcomes.
• Updates policies per state/NCQA requirements; manages training.
• Ensures staff are versed in program requirements and processes.
• Implements tracking of KPIs, reviews, and gap analyses.
• Applies PDSA cycles for process improvement.
• Hires, trains and manages the team; travel up to 25% as needed.

Skills

Quality improvement

HEDIS/NCQA knowledge

CAHPS improvement

Data analysis

Leadership

Project management

Communication

Education

CPHQ

CHCA

RN

Tools

Excel

Job description

JOB DESCRIPTION Job Summary

Leads and directs team responsible for quality management and quality performance improvement activities. Responsible for overseeing, planning, and implementing new and existing health plan quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key quality program activities, and provides support and implementation of National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state quality improvement compliance activities, including compliance with Healthcare Effectiveness Data and Information Set (HEDIS) regulations.

Essential Job Duties

• Directs team responsible for the implementation of key quality program management strategies, including initiation and management of quality program management activities, surveys, audits, and other activities to meet state, federal and National Committee for Quality Assurance (NCQA) regulatory requirements.
• Oversees and leads health plan quality program management and performance activities in compliance with state, federal, and NCQA quality requirements.
• Represents the senior leadership team at internal Molina national and regional meetings; serves as subject matter expert for the health plan at state meetings, and actively oversees the completion of effective performance improvement projects.
• Collaborates with the national analytics and strategic teams to present and evaluate quality performance management program (QPMP) activities.
• 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, document management, report completion, 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, federal and NCQA requirements for all quality program management functions by overseeing the ongoing incorporation and modification of requirements in state-specific policy addendums.
• Manages training and education of quality program management and performance staff in alignment 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 (KPIs), 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.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality/department-specific goals
• Same-day out-of-office travel approximately 0-25% of the time may be required, depending on health plan/state-specific needs.
• Multi-day out of town overnight travel approximately 0-20% of the time may be required, depending upon health plan/state-specific needs.

Required Qualifications

• At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.
• Advanced knowledge and understanding of HEDIS/NCQA.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• State quality improvement (QI) experience.
• Solid business writing experience.
• Strong strategic‑thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data‑driven decision‑making.
• Critical‑thinking, problem‑solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast‑paced, deadline‑driven environment.
• Ability to work in a cross‑functional highly matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Demonstrated experience in leading significant cross‑functional work.
• Provider credentialing and subcontractor monitoring experience.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.

Benefits

• Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $97,299 - $227,679 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.