Program Director, Quality Improvement (Remote)

Molina Healthcare; Akron (OH); Remote; USD 80,000 - 189,000; Full time

Job summary

A major healthcare provider in Ohio is seeking a Program Director for Quality Improvement to oversee healthcare quality initiatives. The role includes leading key performance measurement projects and ensuring compliance with NCQA standards. Candidates should have over 7 years of relevant experience, strong knowledge of HEDIS programs, and proficiency with analytical tools. A Master's degree and relevant certifications are preferred.

Benefits

Competitive benefits and compensation package

Equal Opportunity Employer

Qualifications

• Minimum of 7+ years relevant experience, including at least 5 in health plan quality improvement.
• Demonstrated knowledge and experience with HEDIS programs.
• NCQA Accreditation experience.

Responsibilities

• Oversees, plans, and implements healthcare quality improvement initiatives.
• Leads programs/projects in HEDIS Performance Measurement.
• Monitors and tracks key quality indicators.

Skills

HEDIS Performance Measurement

Data manipulation and interpretation

Quality program leadership

Education

Bachelor's Degree or equivalent

Master's Degree or higher in a related field

Tools

Excel

Visio

Job description

JOB DESCRIPTION

Job Summary

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; 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 Program Director is a key Quality Improvement (QI) leader within the organization, empowered to advise senior management and other departments on Quality strategies and initiatives. This is an individual contributor role that leads programs/projects in one or more of the following critical QI functional areas: HEDIS Performance Measurement, which conducts data collection, reporting and monitoring for key performance measurement activities; Quality Reporting, which develops reports to meet QI requirements and oversees the use of automated software tools and processes; Clinical Quality Interventions, which develops, implements and monitors the success of QI activities; and QI Compliance, which provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities.

• Serves as a QI subject matter expert and leads programs to meet critical Quality needs.

• Manages QI programs with oversight from the Director, AVP and VP as needed.

• Collaborates and facilitates activities with other units at Corporate and within Molina State Plans.

• Provides direction for QI program activities with department leadership including leading Corporate quality initiatives that require timely follow-up, tracking and communication on an on-going basis.

• Communicates with and escalates gaps and barriers in implementation and compliance to department leadership, including proposed resolution.

• Monitors and tracks key quality indicators, programs, and initiatives to reflect the value and effectiveness of the quality program.

• Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll out).

• Collaborates with Molina State Plans to identify areas and strategies for improved reporting and use of reporting tools.

• Leads key Clinical Intervention activities including implementation of national and state-based Quality interventions, meeting state and federal intervention rules and aligned with best practices identified in literature and within Molina plans.

• Works with Molina Plans and QI leadership to ensure that interventions are communicated, monitored, and reported on a timely basis to demonstrate program effectiveness.

• Facilitates and builds high quality clinical care/services through relationships with key departments within Molina and at Molina plans.

• Leads HEDIS Performance Measurement programs using knowledge, skills and technical expertise in performance measurement, data collection and reporting.

• Maintains confidentiality and complies with the Health Insurance Portability and Accountability Act (HIPAA).

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

• Minimum of 7+ years relevant experience, including at least 5 years in health plan quality improvement.

• Demonstrated knowledge of and experience with HEDIS programs.

• 2 years Medicaid experience

• 2 years Medicare experience

• 3 years management experience

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

• Proficiency with data manipulation and interpretation.

• NCQA Accreditation experience.

Preferred Education

Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration.

Preferred Experience

• HEDIS reporting or collection experience

• CAHPS improvement experience

• State QI experience

• 3 years’ experience in Reporting & Analytics

• 3 years’ experience in Health Care Industry

• Quality program leadership and direction

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Nursing License (RN may be preferred for specific roles)

• Certified HEDIS Compliance Auditor (CHCA)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $80,412 - $188,164 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.