Quality Compliance Specialists

Job Summary

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

Knowledge/Skills/Abilities

• Contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.
• Health Plan experience across lines of business (Medicaid/Marketplace).
• Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.
• Makes sure key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.
• Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.
• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.
• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.
• Evaluates project/program activities and results to identify opportunities for improvement.
• Surfaces to Manager and Director any gaps in processes that may require remediation.
• Other tasks, duties, projects, and programs as assigned.

Job Qualifications

• Required Education: Bachelor's Degree or equivalent combination of education and work experience.
• Required Experience: Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.
• Demonstrated solid business writing experience.
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

• PREFERRED FIELD: Clinical Quality, Public Health or Healthcare.

Preferred Experience

• 1 year of experience in Medicaid/Marketplace.
• Certified Professional in Health Quality (CPHQ).
• Nursing License (RN may be preferred for specific roles).
• Certified HEDIS Compliance Auditor (CHCA).

Benefits & Compensation

• Pay Range: $21.82 - $42.55 / HOURLY.
• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.