Remote Health Quality Program Lead (RN)

Molina Healthcare; Seattle (WA); Remote; USD 83,000 - 135,000; Full time

Job summary

Molina Healthcare is seeking a senior clinical quality professional to support quality management programs, audits, data analysis, and improvement initiatives. The role emphasizes outbound outreach to members and providers and ensures compliance with state quality standards.

The position focuses on safety, efficiency, and cost-effective member care, requiring strong collaboration across departments and the ability to apply clinical judgment in near real-time decisions.

Qualifications

• At least 3 years in health care with 1 year in quality management or clinical quality investigations.
• Knowledge of HEDIS/NCQA is a plus.
• Experience in a managed care setting is preferred.

Responsibilities

• Perform quality investigations and ensure compliance with state requirements.
• Track and trend reportable incidents and quality events.
• Conduct quality monitoring audits of medical records and services.
• Present results to leadership and applicable departments.
• Contribute to policy/procedure development reflecting state requirements.

Skills

Attention to detail

Strong communication skills

Critical thinking

Problem solving

Time management

Cross-functional collaboration

Education

RN license (active)

CPHQ preferred

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a senior clinical quality professional to support quality management programs, audits, data analysis, and improvement initiatives. The role emphasizes outbound outreach to members and providers and ensures compliance with state quality standards.

The position focuses on safety, efficiency, and cost-effective member care, requiring strong collaboration across departments and the ability to apply clinical judgment in near real-time decisions.