Specialist, Quality Interventions/QI Compliance (Remote in South TX)

$40,851 - $88,504/Yr

Molina Healthcare - Harlingen, TX

Full-time

Remote - Harlingen, TX

Insurance Carriers and Related Activities

About the position

The Specialist, Quality Interventions/QI Compliance at Molina Healthcare is responsible for overseeing and implementing healthcare quality improvement initiatives and education programs. This role ensures compliance with quality standards, conducts data collection and reporting for performance measurement, and directs NCQA accreditation surveys and federal/state quality improvement compliance activities. The position requires collaboration with various departments to enhance quality interventions and compliance efforts.

Responsibilities

• Implement key quality strategies, including management of provider, member, and community interventions.
• Prepare for Quality Improvement Compliance surveys and other required quality activities.
• Monitor and ensure timely completion of key quality activities, presenting results to management and other departments.
• Write narrative reports interpreting regulatory specifications and documenting program results and limitations.
• Create and manage documentation to maintain critical quality improvement functions.
• Lead quality improvement activities and discussions with other departments.
• Evaluate project/program activities to identify opportunities for improvement.
• Report any process gaps to the Manager and Director.

Requirements

• Bachelor's Degree or equivalent combination of education and work experience.
• Minimum 3 years' experience in healthcare, with at least 1 year in health plan quality improvement or managed care.
• Demonstrated solid business writing experience.
• Operational knowledge and experience with Excel and Visio.

Nice-to-haves

• 1 year of experience in Medicare and Medicaid.
• Certified Professional in Health Quality (CPHQ).
• Nursing License (RN may be preferred for specific roles).
• Certified HEDIS Compliance Auditor (CHCA).

Benefits

• Competitive benefits and compensation package.