Manager, Clinical Quality Interventions - RN Required (Remote)

Lensa; Sioux City (IA); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company in healthcare is seeking a Manager for Clinical Quality Interventions. The role involves developing and monitoring quality improvement initiatives, ensuring compliance with healthcare standards, and leading cross-functional teams. Candidates must possess an active RN license and significant experience in managed healthcare.

Qualifications

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

Responsibilities

• Develops and implements quality improvement interventions.
• Coordinates resources and training within the health plan.
• Leads operations for quality improvement initiatives.

Skills

Quality Improvement

Data Analysis

Project Management

Team Leadership

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)

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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 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 coordinates resources and training within the health plan, identifies barriers to goals and timelines, and leads the interventions Joint Operations Committee, representing Molina Plan 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 effective practices.
• Develops targeted interventions for performance improvement, including outreach to members and providers.
• Leads operations and implementation for Molina Plan quality improvement initiatives using defined roadmaps, timelines, 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 regarding intervention strategies.
• Leads and influences cross-functional teams overseeing quality interventions.
• Implements effective interventions that drive change, with strong knowledge of quality principles.
• Leads qualitative analysis, reporting, and development of program materials.
• 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 2+ years in health plan quality improvement or related roles. 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 License/Certifications

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

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. Equal Opportunity Employer. Pay Range: $77,969 - $155,508 annually. Actual compensation varies based on location, experience, education, and skills.

Additional Details

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