Senior Specialist, Quality Program Management & Performance (Remote)

Senior Specialist, Quality Program Management and Performance

The Senior Specialist, Quality Program Management and Performance implements new and existing healthcare quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key quality program activities. Acts as a lead specialist to provide project, program, and/or initiative related direction. Provides guidance for other specialists within the department and/or collaboratively with other departments to ensure quality programs meet regulatory requirements.

Job Duties

• 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 to ensure quality programs meet regulatory requirements
• Implements key quality program activities that maintain quality compliance, including maintaining responsibility for preparing and finalizing quality program management committee and other meeting documentation, which capture thorough discussion and participation of attendees, follow-up actions, and next steps, in a clear and understandable way
• Oversees quality program management activities, which include preparation for quality improvement audits, surveys, and other federal and state-required quality activities
• Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments, and to formal committees and subcommittees as needed
• Writes narrative reports and works with departmental specialists (as appropriate) to interpret regulatory specifications, explain programs and results of programs, and document findings
• Maintains quality program management project plan to ensure state (and/or federal and NCQA-related) requirements are documented during the year
• Works with the Manager and/or Director to maintain up-to-date addendums to quality policies and procedures that clearly document state-specific activities and requirements in collaboration with the national teams
• 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 the Manager and/or Director any gaps in processes that may require remediation
• Other tasks, duties, projects, and programs assigned
• This position may require same-day out-of-office travel, depending upon the location
• This position may require multiple days' out of town overnight, depending upon location

Job Qualifications

Required Qualifications:

• Bachelor's Degree or equivalent combination of education and work experience
• Min. 3 years of experience in healthcare with a minimum of 2 years of 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 Qualifications:

• Degree in Preferred field: Clinical Quality, Public Health, or Healthcare
• 5 years of experience in health plan quality management
• Experience with data reporting, analysis, and/or 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)