Manager, Clinical Quality Interventions - RN Required (Remote)

Lensa; Akron (OH); Remote; USD 77,000 - 156,000; Full time

Job summary

An innovative healthcare provider is seeking a Clinical Quality Manager to lead quality improvement initiatives. In this pivotal role, you will oversee the development and implementation of strategies that enhance healthcare quality and compliance. You will collaborate with cross-functional teams, ensuring that interventions meet state and federal standards while driving performance improvements. This position offers the opportunity to make a significant impact on patient care and service delivery within a dynamic organization. If you are passionate about quality healthcare and have the leadership skills to drive change, this is the perfect opportunity for you.

Qualifications

• 5+ years in managed healthcare, with 2 years in health plan quality improvement.
• Experience in leading healthcare quality teams and managing interventions.

Responsibilities

• Develop and implement quality improvement interventions for the health plan.
• Coordinate resources and training, and analyze intervention effectiveness.

Skills

Managed Healthcare

Quality Improvement

Data Analysis

Leadership

Communication

Education

Active RN License

Master's Degree in Clinical Field

Tools

Excel

Visio

Job description

Manager, Clinical Quality Interventions - RN Required (Remote)

Manager, Clinical Quality Interventions - RN Required (Remote)

3 days ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

Knowledge/Skills/Abilities

The Manager, Health Plan Quality Interventions is responsible for developing, implementing, and monitoring the success of quality improvement interventions. The Manager works to coordinate resources and training within the health plan and identify barriers to established goals and timelines. Key activities include implementing, monitoring, and analyzing the effectiveness of a comprehensive intervention strategy; and facilitating stakeholder input and strategic direction from the interventions Joint Operations Committee that includes leadership from multi-functional areas. The Manager serves as the primary contact for health plan interventions and leads the interventions Joint Operations Committee representing the Molina Plan Senior Leadership Team. In all activities, the Manager works with the national and regional collaborative analytics and strategic team to present and evaluate intervention strategies.

Only individuals with an RN license are being considered at this time.

• Plans and/or implements Quality interventions that meet state and federal intervention rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina plans.
• Develops and implements targeted interventions related to performance improvement, including member and provider outreach to improve care and service.
• Serves as operations and implementation lead for Molina Plan quality improvement interventions using a defined roadmap, timeline, and key performance indicators.
• Collaborates with the national intervention collaborative analytics and strategic teams to deliver proposed interventions for review and evaluation.
• Communicates with the Molina Plan Senior Leadership Team, including the Plan President, Chief Medical Officer, national intervention collaborative analytics and strategic teams about key deliverables, timelines, barriers, and escalated issues that need immediate attention.
• Presents concise summaries, key takeaways, and action steps about Molina plan intervention strategy to national, regional and plan meetings.
• Demonstrates ability to lead and influence cross-functional teams that oversee implementation of quality interventions.
• Possesses a strong knowledge in quality to implement effective interventions that drive change.
• Functions as key lead for interventions including qualitative analysis, reporting and development of program materials, templates, or policies.
• Provides on-going support to manage and maintain the integrity of established programs/processes and member/provider outreach initiatives.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with health care providers.
  
  

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

5+ years' experience in managed healthcare, including at least 2 years in health plan quality improvement or equivalent/related experience.

2+ years' management experience leading a healthcare quality team.

Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Master's Degree or higher in a clinical field, Public Health or Healthcare.

Preferred Experience

• 3+ years' experience with member/ provider (HEDIS) outreach and/or quality intervention or improvement studies (development, implementation, evaluation).
• Supervisory experience.
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
• Preferred License, Certification, Association
• Certified Professional in Health Quality (CPHQ)
• 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.

Pay Range: $77,969 - $155,508 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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