Mgr, Quality Improvement - NCQA & HEDIS

Company: Molina Healthcare
Location: San Antonio
Posted on: November 22, 2020

Job Description:

Job Description

Job Summary

The Manager, Quality Improvement, assists the Director and AVP with providing the strategic management and implementation of quality improvement intiatives designed to meet NCQA accreditation, and regulatory requirements. The Manager serves as an internal consultant within the plan; providing education, clarifying standards, and helping to resolve identified barriers.

Key activities include:

Lead and/or participate in MHT and MHI committees and workgroups

Manage processes to ensure timely and accurate completion of regulatory and accreditation deliverables, including but not limited to: annual program description, workplan, performance improvement projects, reports, state QAPI responses, EQRO submissions, and ad hoc requests

Collaborates to ensure accountability for timely and accurate completion of internal and external deliverables

Maintains library of accreditation and regulatory updates from NCQA, CMS and state regulators.

Design, implement, monitor and analyze the efficiency and effectiveness of improvment strategies/interventions, as per continuous quality improvement (CQI) prinicples

Surfaces and escalates discrepancies where Health Plan policies and procedures differ materially from standard corporate responsibilities or ensures that any differences have a sound business justification

Identify and solves for and escalates process barriers adversly impacting member or provider satisfaction outcomes or gaps in care

Works to ensure all QI compliance related activities are successfully accomplished each year, including: NCQA Accreditation, CMS Part C and D Data Validation, SNP Structure and Process, SNP Model of Care, or other activities as required.

Coordinates with business units to implement evidence-based improvement strategies for HEDIS, CAHPs, HOS, Medicare Stars and the HHSC MCO Report Card

Functions as key lead for improvement strategies, including qualitative analysis, reporting and development of program materials, templates or policies. Provides on-going support to manage and maintain the integrity of established programs/processes and member/provider outreach initiatives

Maintains strong knowledge of NCQA standards, HEDIS, and specifications requirements to support MMP, Marketplace, Medicare and Medicaid lines of business as assigned

Manage QI staff, including delegating tasks and meetings, setting deadlines, establishing goals, coaching and demonstrating consistent accountability for performance

Other duties as assigned

J OB FUNCTION:

Molinas Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI Improvement activities; supports Quality Improvement Committee and Subcommittes.

Job Qualifications

Required Education

Bachelor's Degree or equivalent work experience.

Required Experience

• 5+ years experience in managed healthcare, including at least 2 years in health plan quality improvement or equivalent/related experience.

• NCQA Accreditation experience

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Required License, Certification, Association

N/A

Preferred Education

Master's Degree or higher in a clinical field, Public Health or Healthcare.

Preferred Experience

• HEDIS reporting or collection

• CAHPS improvement experience

• Texas Medicaid & MMP QI experience.

• Provider credentialing; PQOC review

• Medicaid experience, MMP, Medicare, Marketplace

• Supervisory experience.

• Project management and team building experience.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Nursing License (RN may be preferred for specific roles)

• Certified HEDIS Compliance Auditor (CHCA)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Keywords: Molina Healthcare, San Antonio , Mgr, Quality Improvement - NCQA & HEDIS, Other , San Antonio, Texas