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

Molina Healthcare, Inc.; United States; Remote; USD 110,000 - 140,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a seasoned quality management leader to oversee and drive quality improvement activities across health plans. You will ensure NCQA/HEDIS compliance and regulatory alignment, provide SME support for quality initiatives, and lead documentation, audits, and reporting processes.

The role requires strong analytical, writing, and project management skills, with the ability to work with cross-functional teams and state/federal stakeholders. Some travel may be required.

Qualifications

• Experience with health plan quality improvement and NCQA/HEDIS compliance requirements.
• Strong writing, reporting, and data interpretation skills.
• Ability to drive process improvements and manage projects in a fast-paced environment.
• Knowledge of state and federal quality program requirements.

Responsibilities

• Lead quality program management activities to ensure NCQA and regulatory compliance.
• Provide SME support for quality-related projects and initiatives.
• Prepare and finalize quality program meeting documentation and follow-up actions.
• Oversee preparation for quality improvement reports, audits, and surveys.
• Monitor completion of key quality activities and present results to leaders and committees.
• Collaborate with leadership to maintain up-to-date quality policies and procedures.
• Create and manage documentation for critical quality improvement functions.
• Lead cross-functional quality improvement discussions and escalation remediation.

Skills

HEDIS/NCQA

Data analysis

Quality improvement

Regulatory compliance

Project management

Attention to detail

Communication skills

Education

CPHQ certification

CHCA certification

RN licensure (active)

Tools

Excel

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

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.

Essential Job Duties

• 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.

Required Qualifications

• 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.
• 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.
• Project management experience.
• Strong 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

• 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.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Project management 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.

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