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

Molina Talent Acquisition; Phoenix (AZ); On-site; USD 90,000 - 120,000; Full time

Job summary

Molina Healthcare is seeking a senior-level quality management professional in Arizona to provide clinical support to quality programs, audits, data analysis, and improvement initiatives. The role focuses on safe, efficient, and compliant member care and requires an active AZ RN license and at least 3 years in health care with 1 year in quality management.

The position emphasizes adherence to state requirements, cross-functional collaboration, and timely investigations.

Qualifications

• 3+ years in health care with at least 1 year in quality management and clinical quality investigations
• Active and unrestricted RN license in Arizona
• Experience with quality auditing, peer review and process improvement
• Strong attention to detail, critical thinking and problem solving
• Ability to work cross-collaboratively in a matrixed organization
• Excellent verbal and written communication skills
• Proficiency in MS Office and related software

Responsibilities

• Lead or support senior quality investigations and audits to ensure timely and accurate completion
• Track and trend reportable incidents, quality events, member concerns and mortalities
• Conduct quality monitoring audits of medical records, services and sites
• Present results to departmental leadership and other stakeholders as needed
• Help implement quality strategies requiring near real-time clinical decision making
• Develop and revise policies reflecting state contract requirements and program needs
• Support day-to-day quality management processes and identify improvement opportunities
• Escalate process gaps to leadership and contribute clinician perspectives to remediation efforts

Skills

Attention to detail

Critical thinking

Problem solving

Verbal communications

Written communications

Microsoft Office proficiency

Education

RN license (Arizona)

Tools

Microsoft 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.