Manager, Clinical Quality Interventions - RN Required (Remote)

Lensa; Bellevue (WA); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare organization is seeking a Manager for Clinical Quality Interventions. This remote role involves developing and monitoring quality improvement initiatives, collaborating with various teams, and leading cross-functional efforts to enhance healthcare quality. The ideal candidate will have significant experience in managed healthcare and a valid RN license.

Qualifications

• 5 years in managed healthcare, including 2 years in health plan quality improvement.
• 2+ years' management experience leading healthcare quality teams.

Responsibilities

• Plan and implement quality interventions aligned with state and federal rules.
• Lead operations and implementation of quality interventions using defined roadmaps.

Skills

Leadership

Collaboration

Communication

Analytical Skills

Education

Master's Degree or higher in a clinical field

Active, unrestricted RN License

Tools

Excel

Visio

Job description

Manager, Clinical Quality Interventions - RN Required (Remote)

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Job Description

Job Summary

Molina's Quality Improvement function oversees, plans, and implements healthcare quality improvement initiatives and education programs. It ensures maintenance of programs for members in accordance with prescribed quality standards. The team 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 coordinates resources and training within the health plan, identifies barriers to goals and timelines, and implements, monitors, and analyzes intervention strategies. The role involves facilitating stakeholder input from the interventions Joint Operations Committee, which includes leadership from multiple areas. The Manager acts as the primary contact for health plan interventions and leads the interventions Joint Operations Committee, representing Molina Plan Senior Leadership. Collaboration with analytics and strategic teams at the national and regional levels is essential for presenting and evaluating intervention strategies.

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

Responsibilities

• Plan and implement quality interventions aligned with state and federal rules and best practices.
• Develop and execute targeted performance improvement interventions, including outreach to members and providers.
• Lead operations and implementation of quality interventions using a defined roadmap, timeline, and KPIs.
• Collaborate with analytics and strategic teams to review and evaluate interventions.
• Communicate with senior leadership about deliverables, timelines, barriers, and issues requiring immediate attention.
• Present summaries and action plans at various meetings.
• Lead and influence cross-functional teams overseeing intervention implementation.
• Apply quality knowledge to implement effective change strategies.
• Lead qualitative analysis, reporting, and development of program materials or policies.
• Support ongoing management and integrity of programs and outreach initiatives.
• Facilitate strategic relationships with healthcare providers to support quality care.

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

• At least 5 years in managed healthcare, including 2 years in health plan quality improvement or related areas.
• 2+ years' management experience leading healthcare quality teams.
• Operational knowledge of Excel and Visio.

Preferred Education

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

Preferred Experience

• 3+ years' experience with member/provider outreach and quality intervention studies.
• Supervisory experience.
• Project management and team-building experience.
• Experience developing performance measures supporting business objectives.

Preferred Certifications

• CPHQ (Certified Professional in Health Quality)
• CHCA (Certified HEDIS Compliance Auditor)

Interested current Molina employees should apply through the intranet. Molina Healthcare offers competitive benefits. We are an EOE M/F/D/V.

Compensation Range

$77,969 - $155,508 annually. Actual pay may vary based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider