Sr. Specialist, Provider Engagement- Quality / HEDIS (Remote in AZ)

Company: Molina Healthcare
Location: Tucson
Posted on: May 7, 2024

Job Description:

Job Summary
Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs specific to the Provider Network; ensures maintenance of Provider Quality Improvement programs in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities. -This position requires provider engagement experience in a health plan setting. - -
Knowledge/Skills/Abilities
The Senior Specialist, Provider Engagement contributes to one or more of these quality improvement functions:
--- Will create actionable HEDIS data and analytic insights. -
--- Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.
--- Acts as a lead for provider relations, quality and network development. -
--- 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 in order 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 QualificationsRequired EducationBachelor's Degree or equivalent combination of education and work experience.
Required Experience--- Min. 3 years experience in healthcare with minimum 2 years 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 EducationPreferred field: Clinical Quality, Public Health or Healthcare.
Preferred Experience1 year of experience in Medicare and in Medicaid.Experience with data reporting, analysis and/or interpretation.
Preferred License, Certification, Association--- Certified Professional in Health Quality (CPHQ)--- Nursing License (RN may be preferred for specific roles)--- Certified HEDIS Compliance Auditor (CHCA)To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $49,929.54 - $97,362.61 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#PJCorp
#LI-AC1 Pay Range: $44,936.59 - $97,362.61 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Keywords: Molina Healthcare, Oro Valley , Sr. Specialist, Provider Engagement- Quality / HEDIS (Remote in AZ), Other , Tucson, Arizona