Quality Compliance Specialists

Jobs for Humanity is collaborating with Upwardly Global and Unclassified to build an inclusive and just employment ecosystem. We support individuals coming from all walks of life.

Position:
Specialist, Quality Interventions/QI Compliance (Remote)

Location:

Salem
Company:
Unclassified

Molina’s Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures the 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.

• Contribute to one or more of the quality improvement functions:
  Quality Interventions and Quality Improvement Compliance.
• Implement key quality strategies, including 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.
• Monitor and ensure that key quality activities are completed on time and accurately, presenting results to key departmental management and other Molina departments as needed.
• Write narrative reports to interpret regulatory specifications, explain programs and results, and document findings and limitations of department interventions.
• Create, manage, and compile the required documentation to maintain critical quality improvement functions.
• Lead quality improvement activities, meetings, and discussions with and between other departments within the organization.
• Evaluate project/program activities and results to identify opportunities for improvement.
• Surface to Manager and Director any gaps in processes that may require remediation.
• Perform other tasks, duties, projects, and programs as assigned.

• Required
  
  Education:
  
  Bachelor’s Degree or equivalent combination of education and work experience.
• Required Experience:
  
  Minimum 3 years of experience in healthcare with 1 year 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:
  
  Clinical Quality, Public Health, or Healthcare.
• Preferred Experience:
  
  1 year of experience in Medicaid/Marketplace.
• Certifications:
  
  Certified Professional in Health Quality (CPHQ), Certified HEDIS Compliance Auditor (CHCA). Nursing License (RN) may also be preferred.

Pay Range: $21.82 - $42.55 / HOURLY (may vary based on location and experience).

Molina Healthcare offers a competitive benefits and compensation package.

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