JOB DESCRIPTION

Job Summary

Serves as a leader of quality improvement compliance activities. Oversees national QI compliance activities that support the quality program for all lines of business across all health plans. Responsible for Medicare, Marketplace, and Medicaid program oversight to ensure all areas are compliant.

KNOWLEDGE/SKILLS/ABILITIES

The Director, Quality Program Management and Performance is responsible for leading national Quality compliance and program management activities and acting as a national Quality subject matter expert. Key activities include at least three or more of the following activities, that may not be limited to:

• Serves as a contact to Molina health plans about key quality improvement compliance topics, that may include two or more of the following activities: QI compliance reporting, Medicaid, Marketplace, and Medicare audits and ongoing monitoring, NCQA accreditation, file review audit results and ongoing monitoring, policy and procedure development, policy and procedure auditing and follow up, QI strategies and performance improvement projects, member and provider satisfaction survey development, fielding, vendor management, and analysis, new business development, and quality program documentation and monitoring.

• Supports national/local committees and national workgroups with meeting facilitation, report completion and presentation, and action plan development and monitoring.

• Prepares, in collaboration and support with local Molina plans, required documentation for national and state Performance Improvement Projects and programs for Medicaid, Medicare, and Marketplace.

• Collaborates with the national, regional and state analytics and strategic teams to develop, present and evaluate intervention strategies.

• Collaborates with health plan on accreditation activities that include but are not limited to report development and committee presentation, file review ongoing monitoring and follow up, survey submission, and follow up with NCQA.

• Creates and monitors compliance metrics and presentations that show status of national QI compliance activities.

• Communicates with Plan Presidents, Molina Leadership Teams, Chief Medical Officers, and VPs, Healthcare Services about key deliverables, timelines, barriers and escalated issues that need immediate attention through focused meetings, memos, and other methods.

• Develops and ensures Medicaid, Medicare, and Marketplace interventions are documented for HEDIS, CAHPS and Health Outcomes Survey results within the quality documents and for the Model of Care evaluation.

• Manages new business development opportunities, writing quality responses for Requests for Proposals and providing resources for support.

• Collaborates with MHI HEDIS Operations to provide HEDIS results and other quality information for quality program documentation and reports.

• Presents summaries, key takeaways and action steps about Molina quality strategy to national, regional and plan meetings (internal and external).

• Attends national Molina and local health plan meetings and with external stakeholders to represent quality.

• Collaborates with Potential Quality of Care national team for reporting and/or process improvement.

JOB QUALIFICATIONS

Required Education

Master's Degree or equivalent. Deep knowledge of quality including metrics, compliance requirements, and performance standards.

Required Experience

• Minimum 5 years’ experience in quality compliance, accreditation (as applicable), quality program management, in a managed care setting with leadership level experience (e.g., supervisory experience, project management and team building experience), and compliance experience, within a national or local health plan or national organization.

• Demonstrated ability to lead and influence cross-functional teams that oversee implementation of quality improvement compliance activities.

• Strong knowledge in quality to implement activities and reporting that meets QI compliance requirements that drive change.

• Project management experience, in a managed healthcare setting is important skill set.

• Preferred Experience

• 7+ years’ experience in health plan quality improvement compliance.

• 7+ years’ experience in quality leadership role with a health plan or other related national organization with experience in all lines of business.

Preferred Experience

• RN or clinical license.

• CPHQ certification preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $87,568.7 - $189,732.18 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.