Director Quality Improvement I (4383BR) Columbus, Ohio

Job Summary

Acts as the Quality Leader for the State Health Plan under Corporate guidance. Manages programs surrounding HEDIS, NCQA accreditation, STAR ratings, risk scores for Medicare and Medicaid, CAHPS, HOS, Rx adherence, and state requested reports and projects.

Essential Functions

• Responsible for the program development, implementation, and management of Quality Management and Quality initiatives within the health plan
• Collaborates with health plan Chief Medical Officer in overseeing medical service delivery and quality of care for health plan members
• Support provision of high quality clinical care by building strategic relationships with health care providers
• Support maintenance of marketable, high quality, cost effective provider networks
• Coordinates, directs, and manages the activities of the department and the quality management program
• Responsible for the analysis of the quality of member care, both individual and systematic, received and for the development of plans and programs to support continuous quality improvement
• Establishes strategic plans, policies, and procedures at all levels and with all critical operation departments to ensure quality programs are consistent with overall MHI quality strategies
Responsible for the investigation and resolution of all quality of care grievances.

Knowledge/Skills/Abilities

• Ability to manage quality work and to enforce quality healthcare throughout the organization (proficient).
• Ability to identify barriers to quality healthcare and/or gaps in process that interfere with delivery of quality healthcare (developing).
• Ability to demonstrate strength in strategic and analytical thinking, problem solving, and presentation skills (developing).
• Ability to demonstrate strength in teaming and interpersonal skills, and the ability to initiate and maintain cross-team relationships (proficient).
• Demonstrated ability to meet mission-critical deadlines and to motivate staff to meet these deadlines; proven ability to manage personal stress and those of staff through proactive management and emotional intelligence skills (role model).
• Ability to manage projects, including the ability to manage people and time resources and the ability to monitor the effectiveness of activities (proficient).
• Ability to demonstrate organizational skills (role model).
• Demonstrated mastery of multiple healthcare knowledge areas, including clinical, coding, business operations, and IT analytics (developing).
• Ability to exhibit excellent verbal and written communication skills (proficient).
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) (role model).



Required Education:
BA / BS / BSN or equivalent work experience
Required Experience:
• Minimum of 5 years experience in health plan quality improvement
Required Licensure/Certification/Associations:
 
Preferred Education:
Advanced clinical degree or advanced public health or health care administration degree
Preferred Experience:
• HEDIS reporting or collection 
• CAHPS improvement 
• State QI experience
• NCQA Accreditation
• Medicaid and/or Medicare QI
Preferred Licensure/Certification/Associations:
CPHQ



To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

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

To apply, please click here