Manager, Clinical Quality Interventions - RN Required (Remote)

Lensa; Macon (GA); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company in healthcare is seeking a Manager for Clinical Quality Interventions. This role focuses on developing and implementing quality improvement initiatives, ensuring compliance with healthcare standards, and leading cross-functional teams. Candidates must hold an active RN license and have significant experience in managed healthcare and quality improvement.

Benefits

Competitive benefits

Qualifications

• 5+ years in managed healthcare, including 2+ years in health plan quality improvement.
• 2+ years' management experience.
• Operational knowledge of Excel and Visio.

Responsibilities

• Plans and implements quality interventions aligned with state and federal rules.
• Leads operations and implementation of Molina Plan quality interventions.
• Facilitates strategic relationships with healthcare providers.

Skills

Quality Improvement

Data Analysis

Stakeholder Management

Healthcare Compliance

Education

Active, unrestricted RN License

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

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; maintains programs for members according to quality standards; conducts data collection, reporting, and monitoring for key performance activities; and manages 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 quality improvement interventions. The Manager coordinates resources and training within the health plan, identifies barriers to goals, and ensures effective strategies are in place. Key activities include implementing, monitoring, analyzing intervention effectiveness, and facilitating stakeholder input through the interventions Joint Operations Committee, which includes leadership from multiple areas. The Manager serves as the primary contact for health plan interventions and leads the interventions Joint Operations Committee, representing Molina Senior Leadership. They work with analytics and strategic teams to evaluate intervention strategies.

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

• Plans and implements quality interventions aligned with state and federal rules and best practices in healthcare quality improvement.
• Develops targeted interventions for performance improvement, including member and provider outreach.
• Leads operations and implementation of Molina Plan quality interventions using a defined roadmap, timeline, and KPIs.
• Collaborates with analytics and strategic teams to review and evaluate interventions.
• Communicates with Molina Senior Leadership about deliverables, timelines, barriers, and issues requiring immediate attention.
• Presents summaries and action steps regarding intervention strategies at meetings.
• Leads and influences cross-functional teams overseeing quality interventions.
• Has strong knowledge in quality to implement effective change strategies.
• Leads qualitative analysis, reporting, and development of program materials or policies.
• Supports ongoing management of programs and outreach initiatives.
• Facilitates strategic relationships with healthcare providers to support quality care.

Job Qualifications

Required Education: Active, unrestricted RN License.

Required Experience: 5+ years in managed healthcare, including 2+ years in health plan quality improvement; 2+ years' management experience; 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 with member/provider outreach and quality studies; supervisory experience; project management; developing performance measures.

Preferred Certifications: CPHQ, CHCA.

To apply, current Molina employees should use the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Pay Range: $77,969 - $155,508 annually (may vary by location and experience).

Additional Details

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