Manager, Health Plan Quality Interventions - RN Required (Remote)

Lensa; Houston (TX); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company in healthcare is seeking a Manager for Health Plan Quality Interventions. This role involves overseeing quality improvement initiatives, coordinating resources, and ensuring compliance with healthcare standards. The ideal candidate will have an active RN license and extensive experience in managed healthcare, with a focus on quality improvement and stakeholder engagement.

Qualifications

• Active RN License required.
• 5+ years in managed healthcare, with 2+ years in health plan quality improvement.
• Experience in healthcare management and project management preferred.

Responsibilities

• Develop and implement quality improvement interventions.
• Coordinate resources and training within the health plan.
• Lead cross-functional teams and communicate with senior leadership.

Skills

Quality Improvement

Healthcare Management

Data Analysis

Stakeholder Engagement

Education

Active RN License

Master's Degree or higher in a clinical field

Tools

Excel

Visio

Job description

Manager, Health Plan 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. It ensures maintenance of programs for members in accordance with prescribed 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 within the health plan, identifying barriers to goals, implementing and analyzing intervention strategies, and facilitating stakeholder input through 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 committee, working closely with the national and regional analytics and strategic teams to evaluate 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 outreach to members and providers.
• Leads operations and implementation for Molina Plan quality initiatives using a defined roadmap, timeline, 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 requiring immediate attention.
• Presents summaries, key insights, and action steps to various meetings.
• Leads and influences cross-functional teams implementing quality interventions.
• Possesses strong knowledge in quality to drive effective change.
• Serves as the lead for qualitative analysis, reporting, and development of program materials or policies.
• Provides ongoing support to maintain program integrity and member/provider outreach initiatives.
• Supports high-quality clinical care by building strategic relationships with healthcare providers.

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

At least 5 years in managed healthcare, including 2 years in health plan quality improvement or related roles. Additionally, 2+ years in healthcare management, with 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 in 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)

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Compensation

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: Management