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    Sr. Specialist, Provider Engagement- Quality - Gilbert, AZ, United States - Molina Healthcare

    Molina Healthcare
    Molina Healthcare Gilbert, AZ, United States

    1 month ago

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    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 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).

    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.

    Pay Range: $49, $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: $54, $97,362.61 / ANNUAL
    *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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