Compliance Director - Healthcare jobs in Michigan

Job Description

JOB DESCRIPTION

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.

KNOWLEDGE/SKILLS/ABILITIES

The Program Director is a key Quality Improvement (QI) leader within the organization, empowered to advise senior management and other departments on Quality strategies and initiatives. This is an individual contributor role that leads programs/projects in one or more of the following critical QI functional areas: HEDIS Performance Measurement, which conducts data collection, reporting and monitoring for key performance measurement activities; Quality Reporting, which develops reports to meet QI requirements and oversees the use of automated software tools and processes; Clinical Quality Interventions, which develops, implements and monitors the success of QI activities; and QI Compliance, which provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities.

• Serves as a QI subject matter expert and leads programs to meet critical Quality needs.
• Manages QI programs with oversight from the Director, AVP and VP as needed.
• Collaborates and facilitates activities with other units at Corporate and within Molina State Plans.
• Provides direction for QI program activities with department leadership including leading Corporate quality initiatives that require timely follow-up, tracking and communication on an on-going basis.
• Communicates with and escalates gaps and barriers in implementation and compliance to department leadership, including proposed resolution.
• Monitors and tracks key quality indicators, programs, and initiatives to reflect the value and effectiveness of the quality program.
• Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll out).
• Collaborates with Molina State Plans to identify areas and strategies for improved reporting and use of reporting tools.
• Leads key Clinical Intervention activities including implementation of national and state-based Quality interventions, meeting state and federal intervention rules and aligned with best practices identified in literature and within Molina plans.
• Works with Molina Plans and QI leadership to ensure that interventions are communicated, monitored, and reported on a timely basis to demonstrate program effectiveness.
• Facilitates and builds high quality clinical care/services through relationships with key departments within Molina and at Molina plans.
• Leads HEDIS Performance Measurement programs using knowledge, skills and technical expertise in performance measurement, data collection and reporting.
• Maintains confidentiality and complies with the Health Insurance Portability and Accountability Act (HIPAA).

JOB QUALIFICATIONS

Required Education

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

Required Experience

• Minimum of 7 years relevant experience, including at least 5 years in health plan quality improvement.
• Demonstrated knowledge of and experience with HEDIS programs.
• 2 years Medicaid experience
• 2 years Medicare experience
• 3 years management experience
• Operational knowledge and experience with Excel and Visio (flow chart equivalent).
• Proficiency with data manipulation and interpretation.
• NCQA Accreditation experience.

Preferred Education

Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration.

Preferred Experience

• HEDIS reporting or collection experience
• CAHPS improvement experience
• State QI experience
• 3 years’ experience in Reporting & Analytics
• 3 years’ experience in Health Care Industry
• Quality program leadership and direction

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.

Job Info

Job Identification: 2025024

Job Category: Quality and Risk Adjustment

Posting Date: 2024-03-15T14:40:02 00:00

Job Schedule: Full time