Job Description

JOB DESCRIPTION

Job Summary

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.

Job Duties

• The Supervisor, HEDIS/Quality Reporting supervises staff who contribute to one or more of these quality improvement functions: HEDIS Performance Measurement and Quality Reporting.
• Supervises staff who have the responsibility for the implementation of HEDIS activities, including the identification, collection and abstraction of medical records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers.
• Implements Molina Healthcare goals and/or oversees local processes for HEDIS and/or Quality Reporting.
• Participates in meetings with the corporate HEDIS team, vendors and/or HEDIS auditors. Works with QI management to provide medical record vendor oversight.
• Provides data collection and/or report development support for Quality Improvement studies and performance improvement project.
• Ensures all data-intensive HEDIS and/or reporting activities are accomplished timely and accurately.
• Identifies and oversees new supplemental data sources for use in HEDIS reporting.
• Coordinates HEDIS and QI related projects to meet customers’ expectations.
• Ensures standard rate validations are completed in conjunction with reporting.
• Works with other Health Plan and/or Corporate departments (e.g., Risk Adjustment) to ensure prospective and/or retrospective chart reviews and completed timely and accurately.
• Effectively oversees internal and/or external vendor communications by collaborating and disseminating reports, defining program descriptions, and / or sharing analytical findings.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor’s degree in related field or equivalent experience, OR completion of any of the following programs:
  • Registered Nurse (RN) or State Licensed Vocational Nurse (LVN), or
  • Registered Health Information Technician (RHIT)

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• Min. 4 years experience in healthcare Quality/HEDIS projects/audits

• 2+ years of experience in HEDIS medical records collection and abstraction

• 2+ years of medical record review experience

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

• Bachelor’s degree in related field or equivalent experience, OR completion of any of the following programs:
  • Registered Nurse (RN) or State Licensed Vocational Nurse (LVN), or
  • Registered Health Information Technician (RHIT)

PREFERRED EDUCATION:

Preferred field: Clinical Quality, Public Health or Healthcare.

PREFERRED EXPERIENCE:

• CAHPS improvement experience

• State QI 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)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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.

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