Job Details

JOB DESCRIPTION

Job Summary

This role will report to Molina's Georgia Health Plan and requires residence in Georgia.

Molina's 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 compliance activities.

KNOWLEDGE/SKILLS/ABILITIES

The Associate Vice President is a key Quality Improvement (QI) leader within the organization enterprise wide. This position advises senior management, other corporate departments, and Molina health plans on Quality strategies and initiatives and performs oversight over critical QI functions enterprise wide. These functions include, but may not be limited to: Quality Reporting, HEDIS Performance Measurement, Clinical Quality Interventions, and QI Compliance.

• Works with senior executives, Vice Presidents, and others across Molina Healthcare (within Molina Plans and within various corporate departments) to set and achieve quality goals.
• Develops training, goals and coaching plans for Quality staff.
• Ensures that quality assurance is performed for all reports generated by staff reporting to this position. Examples include reports for Senior Leadership Teams, performance measurement tracking, and medical record review completion status.
• Escalates gaps and barriers in implementation and compliance to VP, Quality, and other corporate senior management as appropriate.
• Serves as a subject matter expert and represents the QI department in meetings and discussions about functional area.
• Collaborates and facilitates activities with other units at corporate and Molina Plans.
• Identifies new QI requirements and builds out processes in advance of effective dates.

JOB QUALIFICATIONS

Required Education

Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration or equivalent combination of education and work experience.

Required Experience

• Minimum of 10 years relevant experience, including at least 5 years in health plan quality improvement.
• 4 years Medicaid/ Medicare experience.
• Minimum 3 years people management experience
• Demonstrated knowledge of and experience with HEDIS programs.
• NCQA Accreditation experience.
• Technical experience in reporting and/or programming.
• Proficiency with Excel and Visio (flow chart equivalent) and demonstrated ability to learn new information systems and software programs.

Preferred Experience

• CAHPS improvement experience
• STARS improvement experience
• State QI experience
• 3+ years experience in Reporting & Analytics
• 3+ years health care information systems experience
• Knowledge of HOS pay for performance, basic experience with other quality metrics like PQI (hospital), NQF-sanctioned measurement.
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
• Provider credentialing; PQOC review
• Preferred License, Certification, Association
• Certified Professional in Health Quality (CPHQ)
• Nursing License
• 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