Sr. Specialist, Quality Program Management & Performance RN (Must reside in AZ)

Molina Healthcare; Phoenix (AZ); On-site; USD 60,000 - 118,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a senior quality professional in Arizona to support quality management programs, audits, and improvements. The role emphasizes safe, efficient, and cost-effective member care within a regulated framework.

You will contribute to state and federal quality compliance efforts and help drive cross-functional quality initiatives across the organization.

Qualifications

• At least 3 years in health care with quality management experience.
• Active, unrestricted RN license in Arizona.
• Experience with health quality audits and peer review.
• Strong attention to detail and problem-solving ability.
• Ability to work across a matrixed organization.

Responsibilities

• Contributes to quality management programs, audits, data analysis, and quality improvement surveys.
• Maintains state/federal quality compliance activities and reports.
• Performs quality monitoring and audits of medical records, services, and sites.
• Presents results to leadership and other departments as needed.
• Supports policy and procedure development reflecting state requirements.

Skills

Quality management

Clinical quality investigations

Cross-functional collaboration

Attention to detail

Time management

Verbal and written communication

Microsoft Office

Education

RN license (Arizona)

CPHQ (preferred)

Tools

MS Office

Job description

JOB DESCRIPTION

Job Summary

Provides senior level clinical support to quality team - contributing to quality management programs, initiatives, audits, data analysis and quality improvement surveys and state/federal quality compliance activities. Contributes to overarching strategy to provide safe, efficient and cost-effective member care.

*Must reside in Arizona*

Essential Job Duties

• Ensures individual and systemic quality of care investigations are performed timely, accurately, and in accordance with state-based requirements.
• Adheres to structure and processes for tracking and trending reportable incidents, quality of care events, member service concerns, and mortalities.
• Performs quality monitoring activities, including audits of medical record quality, services and service sites, health and safety, and follow-up monitoring of placement settings.
• Monitors and ensures that key quality activities that involve clinical decision-making are completed on time and accurately; presents results to key departmental leadership and other departments as needed.
• Implements key quality strategies that require a component of near real-time clinical decision-making. These activities may include initiation and management of interventions (e.g., improving patient safety); preparation and review of potential quality of care and critical incident cases; review of medical record documentation for credentialing and model of care oversight; and any other federal and state required quality activities.
• Adheres to written documentation and business practices (e.g., policies and procedures, desk-level procedures, manuals, and process flows) that explain business requirements and how the unit operationalizes those requirements.
• Supports the creation and ongoing revision of policies and procedures reflective of state requirements for all quality management functions, including quality monitoring audits, credentialing and recredentialing, quality of care concerns, and peer review.
• Demonstrates understanding of requirements of the quality management program and day-to-day work processes to support compliance with state contract, policies, and program requirements.
• Evaluates project/program activities and results to identify opportunities for improvement.
• Raises any gaps in processes that may require remediation to appropriate leadership; may be asked to focus on parts of a process where a clinician's perspective would be valuable to uncover process gaps or limitations.

Required 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. License must be active and unrestricted in Arizona.
• Some states may require 1 year of behavioral health experience (depends on state/contractual requirements).
• Quality auditing, peer review, and process improvement experience.
• 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/applicable software program(s) proficiency.

Preferred Qualifications

• Certified Professional in Health Quality (CPHQ).
• Medical record abstraction experience.
• Managed care experience.
• Ability to work across all levels of the organization, including working with executive audiences, vendors, providers, and the government as a customer.

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

Pay Range

Pay Range: $60,415 - $117,809 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.