Manager, Clinical Quality Interventions - RN Required (Remote)

Lensa; Bowling Green (KY); Remote; USD 77,000 - 156,000; Full time

Job summary

An established industry player is seeking a Clinical Quality Manager to lead innovative healthcare quality improvement initiatives. This pivotal role involves developing and implementing strategies that enhance care quality while ensuring compliance with state and federal regulations. The ideal candidate will possess a strong background in managed healthcare, exceptional leadership skills, and a passion for driving change through data-driven interventions. Join a forward-thinking organization that values collaboration and strategic thinking in delivering high-quality healthcare solutions. This is an exciting opportunity to make a significant impact in the healthcare sector.

Qualifications

• 5+ years in managed healthcare, focusing on quality improvement.
• Experience leading healthcare quality teams and managing projects.

Responsibilities

• Develop and implement quality interventions aligned with healthcare standards.
• Lead cross-functional teams to oversee quality improvement initiatives.

Skills

Managed Healthcare

Quality Improvement

Data Analysis

Project Management

Team Leadership

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)

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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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