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.


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


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.

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Sr Specialist, Quality Interventions - Remote In Mississippi

Molina Healthcare