AVP, National Member Quality Interventions
Provides strategy and leadership to team responsible for enterprise-wide member quality interventions. Responsible for building, delivering, and implementing Molina member facing programs. Oversees health plan quality programs, and implements new and existing health care quality improvement initiatives and education programs to meet quality and risk adjustment goals. Ensures maintenance of quality programs for members in accordance with prescribed quality standards. Oversees data collection, reporting and monitoring for key performance measurement activities and member facing intervention programs, clinical performance, Healthcare Effectiveness Data and Information Set (HEDIS) compliance, and risk adjustment operations across all lines of business, including Medicare, Medicaid, and Marketplace.
Essential Job Duties
• Supports strategy development, vision and direction for enterprise-wide quality member interventions. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
• Advises senior leadership, other corporate departments, and Molina health plans on member facing risk/quality strategies and initiatives, and oversees critical quality improvement (QI) functions enterprise-wide.
• Oversees the corporate quality team delivering program setup/support and develops key performance indicators (KPIs) for quality performance, vendor management, and timeliness of programmatic implementations.
• Collaborates with executive and senior leaders across Molina to set and achieve quality goals.
• Develops training, goals, and coaching plans for member interventions staff that align risk adjustment and quality improvement initiatives.
• Ensures that quality assurance is performed for all quality reports generated by staff.
• Escalates gaps and barriers in implementation and compliance to senior quality leadership, and other corporate senior leadership as appropriate.
• Serves as a subject matter expert and represents the QI department in high-level internal/external quality-related meetings and forums.
• Identifies new QI requirements and builds out and deploys enterprise-wide processes/standards.
• Hires, trains, mentors, develops and manages performance of team; demonstrates accountability for team performance/achievement of established departmental goals.
• Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.
Required Qualifications
• At least 10 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance/risk adjustment, and at least 5 years of Medicaid/Medicare/Marketplace operations experience implementing quality and/or risk intervention initiatives, or equivalent combination of relevant education and experience.
• At least 5 years management/leadership experience.
• Deep knowledge of the quality discipline, including metrics and performance standards.
• Advanced knowledge and understanding of HEDIS/NCQA.
• 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).
• Experience developing performance measures that support business objectives.
• Demonstrated knowledge with the alignment of risk adjustment and quality improvement operations and implementation.
• Familiarity with program implementation and life cycle design (contracting, vendor management, program delivery, KPI tracking, etc.).
• Technical experience in program design, implementation, set-up, and delivery.
• 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
• National level quality improvement experience at a large managed care or provider organization.
• Deep experience with program success metrics creation and delivery.
• Deep Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Deep experience with risk adjustment programs, submission, and success criteria.
• Deep experience with National Committee for Quality Assurance (NCQA) programs and processes.
• Deep Medicare STARS improvement experience.
• Deep state QI experience.
• Health care information systems experience.
• Knowledge of Health Outcomes Survey (HOS) pay for performance (P4P), and basic experience with other quality metrics like prevention quality indicators (PQI).
• Working knowledge of individual state Medicaid risk adjustment operational components, and federal standards for Marketplace and Medicare risk operations.
• 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.
• Experience with aligned risk adjustment and quality metrics performance and program implementation.
• 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.
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