Molina Healthcare - Owensboro, KY
posted 2 months ago
The Manager of Clinical Data Acquisition at Molina Healthcare plays a pivotal role in overseeing the quality improvement initiatives and education programs within the organization. This position is responsible for ensuring that healthcare quality standards are maintained for members, which includes conducting data collection, reporting, and monitoring for key performance measurement activities. The manager will also provide direction and implementation of NCQA accreditation surveys and ensure compliance with federal and state quality improvement activities. In this role, the manager will utilize their knowledge, skills, and technical expertise to manage the critical performance measurement data collection, reporting, and monitoring processes, which include HEDIS, state-based measure reporting, and medical record reviews. The manager will oversee annual HEDIS data collection activities, which involves responding to RFPs, developing HEDIS measures matrix, work plans, and managing product timelines. Collaboration is key in this position, as the manager will work closely with the Director to manage contacts within the plans and Molina corporate, as well as with external auditors, software and medical record vendors, and various Molina departments such as Claims, Enrollment, and IT. The manager will ensure the accuracy and soundness of data used to create HEDIS results and will manage the state's annual CAHPS survey process along with other organizational survey activities. Quality assurance for generated reports, including performance measurement rates, is also a critical responsibility. The manager will be tasked with managing medical record review and performance measurement reporting projects, ensuring that timelines are met, and defining the strategy for in-house versus vendor use for each HEDIS season. They may also implement improvement activities related to HEDIS and CAHPS processes, coordinating with appropriate departments and committees. The role requires maximizing the use of information from various sources, including claims, pharmacy, utilization management, clinical indicators, and survey data, and submitting data to external agencies and quality committees within required timeframes.