Sr Specialist, Quality Interventions - Remote In Mississippi

Molina Healthcare Jackson , MS 39201

Posted 2 months ago

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 Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

  • 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.

  • 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 Qualifications

Required Education

Bachelor'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).

  • Demonstrated knowledge in HEDIS and EPSDT Measures on Quality Interventions with Members and Providers

Required License, Certification, Association

N/A

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 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.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Behavioral Health Specialist (Remote In Mississippi Televideo Assessments

Molina Healthcare

Posted 2 months ago

VIEW JOBS 10/4/2020 12:00:00 AM 2021-01-02T00:00 Job Description Job Summary Molina's Behavioral Health Specialist provides active individualized and/or group therapy in a primary care setting which includes urgent mental health crisis intervention, chronic counseling, and community resources to manage patients' social needs. Behavioral Health Specialist will also provide continuous training and mentoring to clinic staff, providing community resources related and updated emotional and behavioral interventions. Knowledge/Skills/Abilities * Responsible for the face to face assessment and coordination of the psychosocial needs of the patient and family. * Provides various care coordination activities in collaboration with the member's primary care physician, specialist physician, UM staff, disease management staff, medical case manager, mental health professionals, public agencies, and other providers as required. * Coordinates and provides short-term and chronic care counseling with goal focused interventions including patients and families that are age and developmentally appropriate. * Collaborates with Case Managers in managing members with behavioral illness diagnoses. Case management includes ongoing assessment of health needs, individualized care plans, implementation, monitoring and evaluation of outcomes. * Provides leadership and direction to ensure appropriate follow-through, reporting an documentation for the members. Job Qualifications Required Education Master's Degree in Social Work Required Experience * 1-3 years social work experience. * Must have experience in a clinical setting with a working knowledge of a variety of medical concerns as well as mental health and chemical dependency treatment. Required License, Certification, Association * Licensed Clinical Social Worker (LCSW)/ Licensed Independent Social Worker (LISW) * Must be Certified to practice in specific State(s) Preferred Experience * Experience in discharge planning, home health or transitional care. * Knowledge of social support systems and resources. * Knowledge of NCQA requirements related to behavioral health conditions * Knowledge of EPIC electronic medical records 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. Molina Healthcare Jackson MS

Sr Specialist, Quality Interventions - Remote In Mississippi

Molina Healthcare