Sr. Specialist, Provider Engagement- Quality / HEDIS (Remote in AZ)

Job Summary

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs specific to the Provider Network;

ensures maintenance of Provider Quality Improvement programs in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities.

This position requires provider engagement experience in a health plan setting.

Knowledge / Skills / Abilities

The Senior Specialist, Provider Engagement contributes to one or more of these quality improvement functions :

• Will create actionable HEDIS data and analytic insights.
• Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and / or collaboratively with other departments.
• Acts as a lead for provider relations, quality and network development.
• Implements key quality strategies, which may include initiation and management of provider, member and / or community interventions (e.

g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.

• Monitors and ensures that key quality activities are completed on time and accurately in order to present results to key departmental management and other Molina departments as needed.
• Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.
• Creates, manages, and / or compiles the required documentation to maintain critical quality improvement functions.
• Leads quality improvement activities, meetings and discussions with and between other departments within the organization.
• Evaluates project / program activities and results to identify opportunities for improvement.
• Surfaces to Manager and Director any gaps in processes that may require remediation.
• Other tasks, duties, projects and programs as assigned..

Job Qualifications

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

• Min. 3 years experience in healthcare with minimum 2 years experience in health plan quality improvement, managed care or equivalent experience.
• Demonstrated solid business writing experience.
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field : Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Experience with data reporting, analysis and / or interpretation.

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.

Pay Range : $49,929.54 - $97,362.61 a year*

Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.

PJCorp

LI-AC1

Pay Range : $44,936.59 - $97,362.61 / ANNUAL

Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.

If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission.

Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Job Type : Full Time Posting Date : 05 / 01 / 2024