Program Director, Quality Improvement (Remote)

Molina Healthcare; United States; Remote; USD 72,000 - 157,000; Full time

Benefits offered by this job

Competitive benefits

EOE employer

Job summary

Molina Healthcare is seeking an experienced quality improvement leader responsible for directing QI programs, NCQA accreditation activities, and education initiatives to support member care and compliance across the organization.

The role emphasizes data collection, reporting, KPI monitoring, and collaboration with senior leaders to implement performance improvements, with a focus on HEDIS metrics, CAHPS, and pay-for-performance concepts.

Qualifications

• At least 8 years in health care with 5+ years in quality improvement/compliance.
• At least 3 years of management/leadership experience.
• Deep knowledge of quality discipline, metrics and performance standards.
• Advanced knowledge of HEDIS/NCQA and accreditation experience.
• CAHPS improvement experience.
• HEDIS reporting/collection experience.
• Medicare Stars program experience.
• Experience with government programs (Medicaid/Medicare/Marketplace).
• Experience developing performance measures supporting business objectives.
• State quality improvement experience.
• Strong business writing and communication skills.
• Proficiency with Microsoft Office (Excel) and related software.

Responsibilities

• Lead quality programs in CI areas such as HEDIS performance measurement, quality reporting, and NCQA accreditation activities.
• Advise senior leaders on quality strategies and initiatives.
• Manage QI programs and interventions in collaboration with senior quality leadership.
• Collaborate with corporate functions and state health plans on QI activities.
• Drive timely follow-up, tracking and communications with stakeholders.
• Monitor and report on key quality indicators and program effectiveness.
• Develop and deploy automated reporting and intervention tools.
• Support cross-functional reporting improvements and quality tool usage.
• Lead clinical intervention activities and communicate outcomes to stakeholders.
• Provide training and support to quality team members.

Skills

QI Leadership

HEDIS/NCQA knowledge

CAHPS improvement

Data analysis

Project management

Communication

Cross-functional collaboration

Excel proficiency

Education

Bachelor's degree in healthcare/related field

RN license (optional)

Tools

Quality reporting tools

Data reporting software

NCQA accreditation tools

Job description

JOB DESCRIPTION Job Summary Provides deep subject matter expertise and leadership for quality improvement (QI) activities. Responsible for new and existing health care 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 National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state QI compliance activities.

Essential Job Duties

• Leads quality programs/projects in one or more of the following critical QI functional areas: Healthcare Effectiveness Data and Information Set (HEDIS) performance measurement (includes conducting data collection, reporting and monitoring for key performance measurement (KPI) activities), quality reporting, oversight of automated quality software tools and processes, clinical quality interventions, implementation and monitoring of the success of QI activities, and QI compliance, which provides the strategic direction and implementation of corporate and/or Molina plan National Committee for Quality Assurance (NCQA) accreditation surveys and federal and state QI compliance activities.
• Serves as a quality improvement (QI) subject matter expert and leads quality programs to meet critical quality needs; advises senior leaders and other functions and departments on quality strategies and initiatives.
• In collaboration with senior quality leadership, manages QI programs and interventions.
• Collaborates and facilitates QI activities in collaboration with corporate functions and state health plans.
• Leads corporate quality initiatives - ensures timely follow-up, tracking and communications with applicable stakeholders.
• Communicates with and escalates gaps and barriers in QI 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 QI programs.
• Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll-out).
• Collaborates cross-functionally to identify areas and strategies for improved reporting and use of quality reporting tools.
• Leads key clinical intervention activities including implementation of national and state-based quality interventions.
• Collaborates cross-functionally 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.
• Leads Healthcare Effectiveness Data Information Set (HEDIS) performance measurement programs - leveraging knowledge, skills and technical expertise in performance measurement, data collection and reporting.
• Provides training and support to new and existing quality team members.

Required Qualifications

• At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Deep knowledge of the quality discipline, including metrics and performance standards.
• Advanced knowledge and understanding of HEDIS/NCQA, including NCQA accreditation experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Medicare Stars program experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• State quality improvement (QI) experience.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Experience in managing provider engagement activities including contract development for quality performance standards.
• Deep Stars improvement, reporting and analytics experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Knowledge of Health Outcomes Survey (HOS) and pay for performance (P4P) models.
• Health care information systems experience.
• Experience in a quality leadership role with a managed care payer with experience in all lines of business (Medicaid, Medicare, and/or Marketplace).
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.

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

Pay Range: $72,370.82 - $156,803.45 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.