Quality Improvement Specialist - HEDIS/NCQA Focus

Molina Talent Acquisition; Milwaukee (WI); Remote; USD 65,000 - 90,000; Full time

Job summary

Molina Healthcare seeks a Quality Management professional to oversee and implement health plan quality improvement activities, ensuring NCQA/HEDIS compliance and regulatory reporting. You will support accreditation surveys and governance across departments.

Responsibilities include coordinating documentation, monitoring audits, and collaborating with teams to drive improvements in quality of care and compliance standards.

Qualifications

• At least 2 years of health care experience with health plan quality improvement.
• Knowledge of HEDIS/NCQA.
• Business writing experience.
• Data analysis, manipulation, interpretation and reporting skills.
• Strong critical-thinking and analytical abilities.
• Attention to detail and organizational skills.
• Ability to work independently in a fast-paced environment.
• Effective verbal and written communication.

Responsibilities

• Supports quality management activities in compliance with NCQA, state, and federal requirements.
• Monitors and ensures quality activities are completed on time and accurately; presents results to leaders.
• Writes or reviews narrative reports interpreting regulatory specifications and program results.
• Assists with projects, programs, and initiatives within the quality department.
• Creates, manages, and maintains documentation for quality improvement functions.
• Participates in cross-functional quality discussions to meet regulatory requirements.
• Raises gaps in quality processes to leadership for remediation.
• Facilitates quality of care investigations and tracks adverse events.
• Monitors and evaluates systems for tracking incidents, quality events, and member concerns.
• Organizes quality monitoring activities including audits of records and services.

Skills

Data analysis

Critical thinking

Attention to detail

Communication skills

Independent work

Microsoft Office

Business writing

Tools

Excel

Job description

Molina Healthcare seeks a Quality Management professional to oversee and implement health plan quality improvement activities, ensuring NCQA/HEDIS compliance and regulatory reporting. You will support accreditation surveys and governance across departments.

Responsibilities include coordinating documentation, monitoring audits, and collaborating with teams to drive improvements in quality of care and compliance standards.