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. The role involves developing and monitoring quality improvement initiatives, ensuring compliance with healthcare standards, and collaborating with various teams. An active RN license is required, along with significant experience in managed healthcare. The position offers competitive benefits and a salary range based on experience.

Benefits

Competitive benefits

Qualifications

• 5+ years in managed healthcare, including 2+ years in health plan quality improvement.
• 2+ years of management experience leading a healthcare quality team.

Responsibilities

• Plans and implements quality interventions aligned with state and federal rules.
• Leads operations and implementation of quality improvement interventions.
• Communicates with Molina Senior Leadership about key deliverables and issues.

Skills

Leadership

Collaboration

Quality Improvement

Data Analysis

Education

Active, unrestricted RN License

Master's Degree or higher in a clinical field

Tools

Excel

Visio

Job description

Manager, Clinical Quality Interventions - RN Required (Remote)

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 healthcare quality improvement initiatives and education programs. It 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 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 role involves coordinating resources and training within the health plan, identifying barriers to goals, and analyzing the effectiveness of intervention strategies. The Manager serves 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 is essential.

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 healthcare quality literature.
• Develops targeted interventions for performance improvement, including outreach to members and providers.
• Leads operations and implementation of quality improvement interventions with defined roadmaps and KPIs.
• Collaborates with analytics and strategic teams to review and evaluate interventions.
• Communicates with Molina Senior Leadership about key deliverables, timelines, barriers, and issues.
• Presents summaries and action steps in meetings.
• Leads and influences cross-functional teams overseeing interventions.
• Has strong knowledge of quality to implement effective change.
• Leads qualitative analysis, reporting, and development of program materials.
• Supports ongoing management of programs and outreach initiatives.
• Facilitates strategic relationships with healthcare providers to support clinical care.

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

5+ years in managed healthcare, including 2+ years in health plan quality improvement or related fields. 2+ years of 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 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

• 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. EOE M/F/D/V. Pay Range: $77,969 - $155,508 annually, varies by location and experience.