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

Lensa; Kearney (NE); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company in healthcare services is looking for a Manager of Health Plan Quality Interventions. This role involves overseeing quality improvement initiatives, managing healthcare teams, and ensuring compliance with quality standards. Candidates must have an active RN license and significant experience in managed healthcare. The position offers a competitive salary and comprehensive benefits.

Qualifications

• 5+ years in managed healthcare, with 2+ years in health plan quality improvement.
• Operational knowledge of Excel and Visio.
• Experience developing performance measures aligned with business goals.

Responsibilities

• Plans and implements quality interventions aligned with state and federal rules.
• Leads operations and implementation of interventions using a defined roadmap.
• Builds strategic relationships with healthcare providers to support quality care.

Skills

Quality Improvement

Team Management

Data Analysis

Stakeholder Engagement

Education

Active, unrestricted RN License

Master's Degree or higher in healthcare

Tools

Excel

Visio

Job description

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

1 day ago 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 according to 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, develops, implements, and monitors 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 various functions. The Manager acts as the primary contact for interventions and leads the committee representing Molina Senior Leadership, collaborating with analytics and strategic teams to evaluate strategies.

Note: Only individuals with an RN license are 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 interventions using a defined roadmap, timeline, and KPIs.
• Collaborates with analytics and strategic teams for intervention review and evaluation.
• Communicates progress, barriers, and issues to senior leadership and stakeholders.
• Presents summaries and action plans in meetings.
• Leads cross-functional teams to execute quality interventions effectively.
• Possesses strong quality knowledge to drive change.
• Leads qualitative analysis, reporting, and development of program materials.
• Supports ongoing management of programs and outreach initiatives.
• Builds strategic relationships with healthcare providers to support quality care.

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

At least 5 years in managed healthcare, with 2+ years in health plan quality improvement, and 2+ years in healthcare team management. Operational knowledge of Excel and Visio.

Preferred Education

Master's Degree or higher in a clinical, public health, or healthcare field.

Preferred Experience

• 3+ years with member/provider outreach and quality studies.
• Supervisory experience.
• Project management and team-building experience.
• Experience developing performance measures aligned with business goals.

Preferred Certifications

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

To apply, current Molina employees should use the intranet. Molina offers competitive benefits and is an EOE M/F/D/V.

Pay Range: $77,969 - $155,508 annually. Actual pay varies based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Management
• Industries: IT Services and Consulting