Health Plan Quality Program Mgmt & Performance Manager (Remote in MI)

Molina Healthcare; Lake Michigan Beach (MI); Teletrabalho; USD 110 000 - 170 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive benefits package

Resumo da oferta

Molina Healthcare is seeking a remote Health Plan Quality Program Mgt & Performance Manager with Michigan Medicaid/Managed Care experience. The role focuses on quality improvement, NCQA accreditation support, and regulatory compliance across state and federal programs.

Travel 0-50% may be required, with potential multi-day trips. Requirements include 6+ years in health care with 4+ years in health plan QI, CP HQ/CHCA certifications preferred, and strong data analysis, reporting, and leadership

Qualificações

• Experience focusing on quality improvement compliance deliverables with state/federal regulators.
• NCQA/HEDIS experience related to QI.
• Experience managing multiple high-priority deliverables and meeting deadlines.
• Strong business writing experience.
• Proficiency with data analysis, manipulation, interpretation and reporting.
• Project management experience.

Responsabilidades

• Provide leadership for quality management and quality performance improvement activities.
• Oversee planning and implementation of health plan quality improvement activities for NCQA accreditation and regulatory compliance.
• Lead quality improvement activities and cross-functional meetings to meet regulatory requirements.
• Prepare and finalize quality program management documentation and follow-up actions.
• Monitor key quality activities and present results to leaders and committees.
• Maintain quality program management plans and addendums with state and NCQA requirements.
• Collaborate with state and national quality leadership to document activities and requirements.
• Create, manage, and compile documentation for quality improvement functions.
• Lead problem-solving and remediation for quality escalations with leadership.
• Provide training and support to team members.
• Travel 0-50% of the time; multi-day overnight travel 0-20% as needed.

Conhecimentos

QI compliance

NCQA/HEDIS knowledge

multi-project management

regulatory reporting

data analysis

training & onboarding

travel readiness

Formação académica

CPHQ

CHCA

Ferramentas

Excel

Descrição da oferta de emprego

Molina Healthcare is hiring for a Health Plan Quality Program Mgt & Performance Manager.

This position is remote; Michigan Medicaid and/or Managed Care experience

• Experience focusing on QI compliance deliverables, specifically related to State and Federal regulators
• Experience with NCQA/HEDIS in relation to QI
• Experience managing multiple high-priority deliverables and working with others to meet deadlines

Provides subject matter expertise and leadership 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.

Drives quality program management activities to ensure compliance with state, federal and National Committee for Quality Assurance (NCQA) regulatory requirements.

• Represents as a subject matter expert to quality management team; provides support for quality-related projects, programs and initiatives, and ensures quality programs meet regulatory requirements.
• Implements key quality program activities that maintain quality compliance; includes maintaining responsibility for preparing and finalizing quality program management committee and other meeting documentation, capturing thorough discussion and participation of attendees, follow-up actions, and documenting next steps in a clear and understandable manner.
• Oversees higher complexity quality program management activities, which include preparation for quality improvement reports, audits, surveys, and other federal, state, and NCQA required quality activities.
• Monitors and ensures that key quality activities are completed on time and accurately, and presents results to key departmental leaders, stakeholders, and formal committees and subcommittees.
• Prepares narrative reports, and works collaboratively with the quality management team to interpret regulatory specifications, explain programs and results of programs, and document findings.
• Maintains quality program management project plan to ensure state, federal, and NCQA-related requirements are documented.
• Collaborates with state and national quality leadership to maintain up-to-date addendums to quality policies and procedures that clearly document state-specific activities and requirements.
• Creates, manages, and/or compiles required documentation to maintain critical quality improvement functions.
• Leads quality improvement activities, meetings, and discussions with cross-functional departments within the organization to ensure quality programs meet regulatory requirements.
• Evaluates quality project/program activities and results to identify opportunities for improvement.
• Engages in problem-solving and remediation of escalations/gaps in collaboration with quality leadership.
• Provides training and support for new and existing quality management team members.
• Same-day out-of-office travel approximately 0-50% 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.

At least 6 years of experience in health care, with at least 4 years of experience in health plan quality improvement, or equivalent combination of relevant education and experience.

• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates
• Strong knowledge and understanding of HEDIS/NCQA.
• Solid business writing experience.
• Proficiency with data analysis, manipulation, interpretation and reporting.
• Ability to implement process improvement initiatives and drive change.
• Project management experience.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.
• Management/leadership experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• State quality improvement (QI) experience.
• Project management experience.
• Certified Professional in Health Quality (CPHQ).
• 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