National Quality Performance Manager - HEDIS (Remote)

Molina Healthcare; Oregon; Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive benefits package

Equal Opportunity Employer

Job summary

Molina Healthcare, Inc. is seeking a Quality Program Manager to provide subject matter expertise for the quality performance solutions team.

The role collaborates with departments across the enterprise to plan, coordinate, and manage resources, and to execute quality improvement initiatives aligned with strategic objectives. The position focuses on quality data collection strategy, analytics, reporting, and ensuring compliance with regulatory guidelines while driving improvement opportunities

Qualifications

• 3+ years of program/project management experience in quality or equivalent.
• Healthcare experience or strong quality knowledge.
• Ability to simplify complex concepts and communicate clearly.
• Proficiency in data analysis, manipulation, interpretation and reporting.
• Strong quantitative, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work across a highly matrixed organization.
• Effective verbal, written and presentation communication skills.
• Proficiency with Microsoft Office and ability to learn new software.

Responsibilities

• Collaborate with health plan quality leaders to improve outcomes through data collection, analytics and reporting for quality metrics and CAHPS.
• Monitor quality-related projects from inception to delivery.
• Oversee data ingestion, validation and documentation to improve data accuracy.
• Analyze quality data to identify performance improvement opportunities.
• Ensure compliance with regulatory audit guidelines and maximize HEDIS audit success.
• Partner cross-functionally to ensure data quality delivery.
• Create and maintain quality program documentation and reports.
• Communicate quality status updates to stakeholders on a regular basis.
• Meet customer expectations and maintain strong relationships with stakeholders.

Skills

Project management

Healthcare knowledge

Data analysis

Communication

Cross-functional collaboration

Attention to detail

Regulatory awareness

Tools

Excel

SQL

Job description

JOB DESCRIPTION

Job Summary

Provides subject matter expertise for Molina's quality performance solutions team. Collaborates with various departments and stakeholders across the enterprise to plan, coordinate, and manage resources, and execute quality performance improvement initiatives in alignment with strategic objectives.

Essential Job Duties

• Collaborates with health plan quality leaders to improve outcomes by managing quality data collection strategy, analytics, and reporting for the following: quality rate trending and forecasting, provider quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement.
• Monitors quality-related projects from inception through successful delivery.
• Oversees quality data ingestion activities through data validation, issue identification, and documentation to improve completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact.
• Analyzes quality data and identifies potential performance improvement opportunities.
• Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines, and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success.
• Partners with cross-functional teams to ensure data quality delivery through sequential transformations and identifies opportunities to close quality care gaps.
• Creates, reviews, and updates quality-related program documentation, including plans, reports, and records, and ensures information is accessible for quality teams throughout the enterprise.
• Proactively communicates regular quality-related status reports to stakeholders, highlighting progress, risks, and issues.
• Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.

Required Qualifications

• At least 3 years of program/project management experience in quality, or equivalent combination of relevant education and experience.
• Health care experience or demonstrated functional quality knowledge.
• Intellectual agility and ability to simplify and clearly communicate complex concepts.
• Proficiency with data analysis, manipulation, interpretation, and reporting.
• Strong quantitative aptitude, critical-thinking, problem-solving, and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Effective verbal, written and presentation communication skills.
• Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs.

Preferred Qualifications

• Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server.
• Intermediate knowledge/experience related to National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS), and state-specific regulatory submission requirements.
• Knowledge of health care claim elements: Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine - Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), National Provider Identifiers (NPIs), and Taxpayer Identification Numbers (TINs).
• Experience working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
• Project Management Professional (PMP).
• Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V