Sr Quality Improvement, HEDIS Spec, Health Plan Interventions (Remote In Ohio)

About the role

Molina Healthcare is hiring for a Senior Quality Improvement/HEDIS Specialist on their Health Plan Community Interventions team. This role is remote but candidates must live in Ohio. The role focuses on Quality Improvement using QI Science and supporting improvement work for Medicare Stars Measures.

Responsibilities

• Implements evidence-based and data-informed key member intervention strategies including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
• Maintains accuracy and timely completion of key member intervention activities and presents results to key departmental management and other applicable Molina departments.
• Writes narrative reports to interpret regulatory specifications, explain programs and results, and document findings and limitations of department interventions.
• Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
• Participates in quality improvement (QI) activities, meetings, and discussions with and between other departments within the organization.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs).
• Evaluates quality project/program activities and results to identify opportunities for improvement.
• Raises gaps in processes that may require remediation to quality leadership.
• Provides support for quality-related projects.
• Trains and supports new and existing quality member interventions team members.
• Demonstrates flexibility when it comes to change management and maintains a positive outlook.

Requirements

• At least 3 years of experience in health care, and at least 2 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
• Demonstrated solid business writing experience.
• Proficiency with data analysis, manipulation, and interpretation.
• Intermediate knowledge and understanding of HEDIS and NCQA.
• Critical-thinking, problem-solving, and analytical skills.
• Attention to detail and organizational skills.
• Ability to navigate change with flexibility and a positive outlook.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Experience with data reporting, analysis, and interpretation.
• Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN).

Benefits

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

Pay

Pay Range: $54,922 - $107,099 / ANNUAL

Schedule

This position may require same day out of office travel 0 - 80% of the time, depending upon state-specific needs. This position may require multi-day overnight travel on occasion, depending upon state-specific needs.