Director, Quality Program Management & Performance - REMOTE

$87,569 - $189,732/Yr

Molina Healthcare - Georgetown, KY

Full-time - Senior

Remote - Georgetown, KY

Insurance Carriers and Related Activities

About the position

The Director of Quality Program Management & Performance at Molina Healthcare is responsible for leading national quality improvement compliance activities across various health plans, including Medicare, Marketplace, and Medicaid. This role involves overseeing compliance, managing quality programs, and acting as a subject matter expert in quality improvement. The director will collaborate with various teams to ensure adherence to quality standards and facilitate the development of quality strategies and performance improvement projects.

Responsibilities

• Serve as a contact for Molina health plans regarding key quality improvement compliance topics.
• Support national/local committees and workgroups with meeting facilitation and report completion.
• Prepare required documentation for national and state Performance Improvement Projects for Medicaid, Medicare, and Marketplace.
• Collaborate with analytics and strategic teams to develop and evaluate intervention strategies.
• Manage accreditation activities including report development and follow-up with NCQA.
• Create and monitor compliance metrics and presentations for national QI compliance activities.
• Communicate with Molina leadership about key deliverables and escalated issues.
• Document Medicaid, Medicare, and Marketplace interventions for quality evaluations.
• Manage new business development opportunities and write quality responses for RFPs.
• Present summaries and action steps about Molina quality strategy at meetings.

Requirements

• Master's Degree or equivalent in a relevant field.
• Minimum 5 years' experience in quality compliance and program management in a managed care setting.
• Demonstrated ability to lead and influence cross-functional teams.
• Strong knowledge in quality metrics and compliance requirements.
• Project management experience in a managed healthcare setting.

Nice-to-haves

• 7+ years' experience in health plan quality improvement compliance.
• 7+ years' experience in a quality leadership role with a health plan or related organization.
• RN or clinical license.
• CPHQ certification.

Benefits

• Competitive benefits and compensation package.