Manager, Clinical Quality Interventions - RN Required (Remote)

Lensa; Orlando (FL); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare company is seeking a Manager for Clinical Quality Interventions. This role requires an active RN license and involves developing and implementing quality improvement initiatives within the health plan. The ideal candidate will have significant experience in managed healthcare and a strong background in quality improvement strategies.

Qualifications

• 5+ years in managed healthcare, including at least 2 years in health plan quality improvement.
• 2+ years' management experience leading a healthcare quality team.
• Strong knowledge of quality to drive effective change.

Responsibilities

• Develops, implements, and monitors quality improvement interventions.
• Coordinates resources and training within the health plan.
• Communicates with senior leadership about key deliverables and issues.

Skills

Quality Improvement

Leadership

Data Analysis

Communication

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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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 healthcare quality improvement initiatives and education programs. It ensures the 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 for 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 analyzes the effectiveness of interventions. They facilitate stakeholder input and strategic direction 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. They collaborate 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 effective healthcare practices.
• Develops and executes targeted interventions for performance improvement, including member and provider outreach.
• Leads operations and implementation of quality improvement interventions using a defined roadmap, timeline, and KPIs.
• Collaborates with analytics and strategic teams to review and evaluate interventions.
• Communicates with senior leadership about key deliverables, timelines, barriers, and issues requiring immediate attention.
• Presents summaries and action steps regarding intervention strategies in meetings.
• Leads and influences cross-functional teams to implement quality interventions.
• Has strong knowledge of quality to drive effective change.
• Leads qualitative analysis, reporting, and development of program materials or policies.
• Provides ongoing support to maintain program integrity and outreach initiatives.
• Supports high-quality clinical care by building relationships with healthcare providers.

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

5+ years in managed healthcare, including at least 2 years in health plan quality improvement or related fields. 2+ years' management experience leading a healthcare quality team. 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 or improvement studies.
• Supervisory experience.
• Project management and team-building experience.
• Experience developing performance measures supporting business objectives.

Preferred Certifications

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

To apply, current Molina employees should use the intranet job listing. Molina Healthcare offers competitive benefits. We are an EOE M/F/D/V.

Additional Details

• Pay Range: $77,969 - $155,508 annually (may vary based on location, experience, education, skills)

Job Details

• Senior Level: Mid-Senior
• Employment Type: Full-time
• Job Function: Healthcare Provider
• Industries: IT Services and Consulting