Manager, Clinical Quality Interventions - RN Required (Remote)

Lensa; Rio Rancho (NM); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare organization is seeking a Manager for Clinical Quality Interventions. This role requires an active RN license and involves developing and implementing quality improvement initiatives. The successful candidate will collaborate with various teams, lead intervention strategies, and ensure compliance with healthcare standards.

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.
• Experience with member/provider outreach and quality intervention studies.

Responsibilities

• Develops and implements quality improvement interventions.
• Coordinates resources and training for quality interventions.
• Leads cross-functional teams overseeing quality interventions.

Skills

Leadership

Collaboration

Analytical Skills

Project Management

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)

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; ensures maintenance of programs for members in accordance with 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 role involves coordinating resources and training, identifying barriers, implementing and analyzing intervention strategies, 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 Plan Senior Leadership. The role requires collaboration 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.
• Develops targeted interventions for performance improvement, including outreach to members and providers.
• Leads operations and implementation of quality interventions using a defined roadmap, timeline, and KPIs.
• Collaborates with analytics and strategic teams to review proposed 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.
• Implements effective quality interventions that drive change.
• Leads qualitative analysis, reporting, and development of program materials or policies.
• Supports program integrity and member/provider outreach initiatives.
• Facilitates strategic relationships with healthcare providers to support clinical care and services.

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 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. Molina Healthcare offers competitive benefits. EOE M/F/D/V.

Additional Details

• Pay Range: $77,969 - $155,508 annually (varies by location, experience, education, skills)
• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider