Molina Healthcare - Louisville, KY
posted 2 months ago
Molina's Quality Improvement function plays a crucial role in overseeing, planning, and implementing healthcare quality improvement initiatives and education programs. This position is responsible for ensuring that programs for members are maintained in accordance with prescribed quality standards. The Manager of Clinical Data Acquisition will conduct data collection, reporting, and monitoring for key performance measurement activities, while also providing direction and implementation of NCQA accreditation surveys and federal/state quality improvement compliance 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 review. The Manager will oversee annual HEDIS data collection activities, which involves responding to RFPs as needed, developing the HEDIS measures matrix, creating HEDIS work plans, and managing all product timelines. Collaboration is key in this position, as the Manager will work closely with the Director to manage contacts within the plans and/or Molina corporate, as well as with external auditors, software and medical record vendors, and other Molina departments such as Claims, Enrollment, and IT. This role also requires ensuring the soundness and correctness of data used to create HEDIS results, managing the state's annual CAHPS survey process, and overseeing other organizational survey activities, including the annual Provider Satisfaction Survey. Quality assurance is a critical component of this role, as the Manager will ensure that quality assurance is performed for generated reports, including performance measurement rates. The Manager will also manage medical record review and performance measurement reporting projects for assigned areas, ensuring that timelines are met and defining the use of in-house versus vendor strategies for each HEDIS season. Additionally, the Manager may implement improvement activities directly related to HEDIS and CAHPS processes, coordinating with appropriate departments and committees on other initiatives. The role requires maximizing the use of information from multiple sources, including claims/encounters, pharmacy, utilization management, clinical indicators, industry benchmarks, and survey/vendor data, and submitting data to external agencies and quality committees within required timeframes.