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Sr Specialist, Quality Interventions/QI Compliance (Remote in Ohio)
$44,937 - $97,363/Yr
Molina Healthcare - Toledo, OH
posted 2 months ago
Full-time
Remote - Toledo, OH
Insurance Carriers and Related Activities
About the position
The Senior 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.
Responsibilities
- Provide project, program, and initiative-related direction and guidance for other specialists within the department and collaboratively with other departments.
- Implement key quality strategies, including management of provider, member, and community interventions.
- Monitor and ensure timely and accurate completion of key quality activities, presenting results to management and other departments as needed.
- Write narrative reports interpreting regulatory specifications and documenting findings of department interventions.
- Create and manage documentation to maintain critical quality improvement functions.
- Lead quality improvement activities, meetings, and discussions with other departments.
- Evaluate project/program activities to identify opportunities for improvement.
- Report any gaps in processes 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 2 years 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.
- Experience with data reporting, analysis, and interpretation.
- Active, unrestricted Certified Professional in Health Quality (CPHQ).
- Active, unrestricted Nursing License (RN may be preferred for specific roles).
- Active, unrestricted Certified HEDIS Compliance Auditor (CHCA).
Benefits
- Competitive benefits and compensation package.
