Remote Senior Health Quality Program Manager & Performance

Molina Healthcare, Inc.; Bothell (WA); Remote; USD 90,000 - 120,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a senior-level clinical quality professional to support the quality team with audits, data analysis and improvement initiatives across state and federal requirements.

This remote role focuses on outbound outreach to members and providers about health, wellness and prevention information, while ensuring high-quality care and compliance. RN licensure and strong communication skills are essential.

Qualifications

• At least 3 years in health care with 1 year in quality management or quality investigations.
• RN license must be active and unrestricted in state of practice.
• Knowledge of HEDIS and NCQA is preferred.
• Experience with quality auditing and process improvement.
• Strong communication and analytical skills

Responsibilities

• Ensure quality of care investigations are timely and compliant with state requirements.
• Track and trend reportable incidents and quality events.
• Perform quality monitoring and audits of medical records and services.
• Present results to leadership and other departments as needed.
• Support policy/procedure development reflecting state requirements.
• Identify improvement opportunities from program activities.

Skills

Quality management

Clinical quality investigations

Data analysis

Cross-functional collaboration

Attention to detail

Communication skills

Time management

Education

Registered Nurse (RN) license

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. is seeking a senior-level clinical quality professional to support the quality team with audits, data analysis and improvement initiatives across state and federal requirements.

This remote role focuses on outbound outreach to members and providers about health, wellness and prevention information, while ensuring high-quality care and compliance. RN licensure and strong communication skills are essential.