国家质量干预主任（会员计划） - 远程
Director, National Quality Interventions (Member Programs) - REMOTE
职位概述
领导并指导负责质量干预活动的团队。负责规划、实施和监督新的及现有的医疗保健质量改进（QI）计划和教育项目。确保根据规定的质量标准维护会员的项目；进行数据收集、报告和监测关键绩效测量活动，并提供国家质量保证委员会（NCQA）认证调查和联邦/州QI合规活动的方向和实施方案。
主要职责
• 与高级质量领导合作，规划和/或实施符合州和联邦干预规则的全国性或基于州的质量干预（QI），这些规则与已建立的质量相关最佳实践一致，包括干预项目和问题解决。
• 开发并实施与医疗效果数据和信息集（HEDIS）绩效改进相关的针对性干预措施，包括对会员和提供者的接触以提高护理和服务。
• 作为QI操作和实施负责人，使用既定路线图、时间表和关键绩效指标（KPIs）。
• 在Molina内部全国和地区会议中担任指定的质量负责人，并在州会议中作为健康计划的主题专家；积极监督有效绩效改进项目的完成。
• 作为干预措施的主要联系人，包括定性分析、报告和项目材料、模板和/或政策的开发；持续支持管理并维护现有项目/流程和会员/提供者接触计划的完整性，并领导干预联合运营委员会（JOC）。
• 与全国干预协作分析和战略团队合作，提交干预措施供审查和评估。
• 与高级领导和全国干预协作分析和战略团队合作，处理关键质量交付物、时间表、障碍和升级的问题。
• 在全国/健康计划会议上，就计划干预策略提出简洁的总结、关键要点和行动步骤。
• 确保Molina健康计划对州规定质量活动的及时和准确完成负责。
• 直接与Molina健康计划合作，协调资源
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Job Summary
Leads and directs team responsible for quality interventions activities. Responsible for planning, implementing, and overseeing new and existing health care quality improvement (QI) 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 National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state QI compliance activities.
Essential Job Duties
• In collaboration with senior quality leadership, plans and/or implements national and/or state-based quality interventions (QI) that meet state and federal intervention rules aligned with established quality-related best practices, including intervention projects and problem resolution.
• Develops and implements targeted interventions related to Healthcare Effectiveness Data and Information Set (HEDIS) performance improvement, including member and provider outreach to improve care and service.
• Serves as operations and implementation lead for QI using a defined roadmap, timeline and key performance indicators (KPIs).
• Represents as designated quality lead at internal Molina national and regional meetings, and serves as subject matter expert for the health plans at state meetings; actively oversees the completion of effective performance improvement projects.
• Serves as the primary contact for interventions, including qualitative analysis, reporting and development of program materials, templates and/or policies; provides ongoing support to manage and maintain the integrity of established programs/processes and member/provider outreach initiatives, and leads the interventions Joint Operations Committee (JOC).
• Collaborates with the national intervention collaborative analytics and strategic teams to deliver proposed interventions for review and evaluation.
• Collaborates with senior leaders and the national intervention collaborative analytics and strategic teams on key quality deliverables, timelines, barriers and escalated issues.
• Presents concise summaries, key takeaways and action steps related to plan intervention strategies at national/health plan meetings.
• Ensures Molina health plans are held accountable for timely and accurate completion of state-mandated quality activities.
• Collaborates directly with Molina health plans to coordinate resources and training, and identify barriers to established quality goals and timelines.
• Develops and implements Molina medical record pursuit strategies and processes, and oversees record operations in collaboration with the HEDIS operations team; assists with integration of strategic partners, acquisitions and start-up plans relative to HEDIS medical records collection/abstraction.
• Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with health care providers.
• Chairs collaborative workgroups to develop strategies for effective QI intervention programs; interfaces and supports other medical care management, disease management or care coordination activities; oversees scheduling, execution and follow-up for regulators, physicians, nurses, pharmacists and providers.
• Conducts periodic audits/reviews of established corporate and health plan programs for efficiency, effectiveness and adherence to policy, and provides recommendations to be used system-wide for process improvement purposes.
• Hires, trains, mentors, develops and manages performance of team; demonstrates accountability for team performance/achievement of established departmental goals.
Required Qualifications
• At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Deep knowledge of the quality discipline, including metrics and performance standards.
• Advanced knowledge and understanding of HEDIS/NCQA, including NCQA accreditation experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Medicare Stars program experience.
• Experience developing performance measures that support business objectives.
• State quality improvement (QI) experience.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.
Preferred Qualifications
• Experience in managing provider engagement activities including contract development for quality performance standards.
• Deep Stars improvement, reporting and analytics experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Knowledge of Health Outcomes Survey (HOS) and pay for performance (P4P) models.
• Health care information systems experience.
• Experience in a quality leadership role with a managed care payer with experience in all lines of business (Medicaid, Medicare, and/or Marketplace).
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
· Experience with Power BI reporting.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Originally posted on Himalayas