Remote Health Plan Quality Program Lead

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

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a senior clinical quality support professional to join the quality team in a remote capacity. You will contribute to quality programs, audits, data analysis, and compliance activities while supporting safe, cost-effective member care.

The role focuses on outbound outreach to members and providers to share health, wellness, or prevention information, and works within a matrixed organization to drive quality improvements.

Qualifications

• At least 3 years experience in health care, with a minimum of 1 year of experience in quality management and clinical quality investigations, preferably in a managed care setting, or equivalent experience.
• Registered Nurse with active license in state of practice.
• Quality auditing, peer review, and process improvement experience.
• Knowledge of HEDIS and NCQA.
• Strong attention to detail, critical-thinking, and problem solving skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Time-management skills and ability to multi-task.
• Excellent verbal and written communication skills.
• Microsoft Office suite proficiency.

Responsibilities

• Ensures quality investigations are performed timely and in accordance with state requirements.
• Tracks and trends reportable incidents, quality of care events, member service concerns, and mortalities.
• Performs quality monitoring activities, including audits of medical record quality and services.
• Monitors and presents results to department leadership as needed.
• Implements key quality strategies requiring near real-time clinical decision-making.
• Maintains documentation and policies reflecting state requirements for quality management functions.
• Supports revisions of policies for quality management functions.
• Evaluates project activities to identify opportunities for improvement.
• Raises gaps in processes to leadership and collaborates to remediate.

Skills

Registered Nurse

Quality management

Clinical quality investigations

HEDIS knowledge

NCQA knowledge

Attention to detail

Cross-functional collaboration

Time management

Verbal and written communication

Microsoft Office

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a senior clinical quality support professional to join the quality team in a remote capacity. You will contribute to quality programs, audits, data analysis, and compliance activities while supporting safe, cost-effective member care.

The role focuses on outbound outreach to members and providers to share health, wellness, or prevention information, and works within a matrixed organization to drive quality improvements.