Quality Compliance Specialists

Quality Compliance Specialists

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

Job Title : Specialist, Quality Interventions / QI Compliance (Remote)

Application Deadline : Open Until Filled

Job Location : Salem

Hours Worked Per Week : Not Provided

Shift : Not Provided

Duration of Job : Either Full or Part Time, more than 6 months

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. Only candidates with previous experience in health care quality / HEDIS, report writing and leadership presentation are considered.

The Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions : Quality Interventions and Quality Improvement Compliance. Health Plan experience across lines of business (Medicaid / Marketplace). Implements key quality strategies, which may include 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. Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed. Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions. 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 Manager and Director any gaps in processes that may require remediation. Other tasks, duties, projects, and programs as assigned.

Job Qualifications :

Required Education : Bachelor's Degree or equivalent combination of education and work experience.

Required Experience : Min. 3 years' experience in healthcare with 1 year 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 Education : Preferred field : Clinical Quality, Public Health or Healthcare.

Preferred Experience : 1 year of experience in Medicaid / Marketplace.

Preferred License, Certification, Association : Certified Professional in Health Quality (CPHQ) Nursing License (RN may be preferred for specific roles) Certified HEDIS Compliance Auditor (CHCA)

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $21.82 - $42.55 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.