Molina Healthcare - Lexington, 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 processes involved in performance measurement data collection, reporting, and monitoring, particularly focusing on HEDIS, state-based measure reporting, and medical record reviews. The manager will oversee annual HEDIS data collection activities, which includes 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 Molina's plans and corporate structure, as well as with external auditors, software vendors, and other departments such as Claims, Enrollment, and IT. Ensuring the accuracy and soundness of data used to create HEDIS results is a critical responsibility, along with managing the state's annual CAHPS survey process and other organizational survey activities. Quality assurance is another essential aspect of this role, as the manager will ensure that generated reports, including performance measurement rates, are accurate and reliable. The manager will also oversee medical record review and performance measurement reporting projects, ensuring that timelines are adhered to and defining strategies for in-house versus vendor use during HEDIS seasons. Additionally, the manager may implement improvement activities related to HEDIS and CAHPS processes, coordinating with relevant departments and committees to identify and recommend potential clinical measurement and quality improvement activities. Maximizing the use of information from various sources, including claims, pharmacy, and clinical indicators, is crucial for success in this role. Finally, the manager will be responsible for submitting data to external agencies and quality committees within required timeframes.