Job Details

Overview

Molinas 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.

Responsibilities

• The Mgr, Clinical Data Acquisition uses knowledge, skills and technical expertise to manage the mission critical nature of the performance measurement data collection, reporting and monitoring process, including HEDIS, state-based measure reporting and medical record review.
• Manages annual HEDIS data collection activities. Responsibilities include responding to RFP(s) as needed, development of the HEDIS measures matrix, HEDIS work plans, and all product timelines.
• Works with the Director to manage contacts within the plan(s) and/or Molina corporate, external auditors, software and medical record vendors, and other Molina departments, such as Claims, Enrollment, IT etc, to get appropriate responses and manage contracts and projects as needed.
• Works with corporate resources and relevant vendors to assure the soundness and correctness of data used to create HEDIS results. Manages states annual CAHPS survey process and other organizational survey activities, such as the annual Provider Satisfaction Survey.
• Ensures quality assurance is performed for generated reports including performance measurement rates.
• Manages medical record review and performance measurement reporting projects for assigned area(s) ensuring timelines are met. Defines use of in-house vs. vendor strategy for each HEDIS season.
• May implement improvement activities directly related to HEDIS and CAHPS processes; coordinates with appropriate departments and committees on others. Identifies and recommends potential clinical measurement and quality improvement activities.
• Maximizes use of information from multiple sources, including claims/encounters, pharmacy, utilization management, clinical indicators, industry benchmark, and/or survey/vendor data.
• Submits data to external agencies and quality committees within required timeframes.

Qualifications

Required Education

Bachelor's Degree or equivalent work experience.

Required Experience/Knowledge, Skills & Abilities

• 7+ years experience in managed healthcare Quality/HEDIS project management and HEDIS Audit
• Demonstrated knowledge of and experience with HEDIS programs.
• Proficiency with data manipulation and interpretation.
• Proficiency with Excel and Visio (flow chart equivalent) and demonstrated ability to learn new information systems and software programs.

Preferred Education

Master's Degree or higher in a clinical field, Public Health or Healthcare.

Preferred Experience

• STARS improvement experience
• CAHPS improvement experience
• 3+ years health care information systems experience or in a role as an IS liaison/contact for QI projects.
• State QI experience
• Supervisory experience.
• Project management and team building experience.
• Experience developing performance measures that support business objectives.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $77,969 - $171,058 / ANNUAL