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

Lensa; Las Cruces (NM); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare organization is seeking a Manager for Health Plan Quality Interventions. The role involves developing and implementing quality improvement strategies, managing healthcare quality teams, and ensuring compliance with quality standards. Candidates must have an active RN license and significant experience in managed healthcare.

Qualifications

• Minimum of 5 years in managed healthcare, with at least 2 years in health plan quality improvement.
• 2+ years managing a healthcare quality team.
• Experience with member/provider outreach and quality intervention studies.

Responsibilities

• Develops, implements, and monitors quality improvement interventions.
• Coordinates resources and training, identifies barriers to goals.
• Facilitates stakeholder input through the interventions Joint Operations Committee.

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, 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 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. This role involves coordinating resources and training, identifying barriers to goals, implementing and analyzing interventions, and facilitating stakeholder input through the interventions Joint Operations Committee, which includes leadership from multiple areas. The Manager serves as the primary contact for interventions, leading the committee and working with 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.
• Develops targeted interventions for performance improvement, including outreach to members and providers.
• Leads operations and implementation for quality interventions using defined roadmaps and KPIs.
• Collaborates with analytics and strategic teams on proposed interventions.
• Communicates progress, barriers, and issues to senior leadership and stakeholders.
• Presents summaries and action steps at meetings.
• Leads and influences cross-functional teams for intervention implementation.
• Applies strong quality knowledge to drive change.
• Leads qualitative analysis, reporting, and development of program materials.
• Supports ongoing program integrity and outreach initiatives.
• Facilitates strategic relationships with healthcare providers to ensure quality care.

Job Qualifications

Required Education

Active, unrestricted RN License.

Required Experience

Minimum of 5 years in managed healthcare, with at least 2 years in health plan quality improvement or related roles. 2+ years managing 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 skills.
• Experience developing performance measures supporting business goals.

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 and is an Equal Opportunity Employer. Pay Range: $77,969 - $155,508 annually. Actual compensation varies based on factors such as location, experience, education, and skills.

Additional Details

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

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