Leads and directs team responsible for Molina enterprise clinical data acquisition activities. Responsible for implementing, monitoring, and overseeing chart collection for Healthcare Effectiveness Data and Information Set (HEDIS), and HEDIS-like projects, risk adjustment, risk adjustment data validation, and other state-specific audit projects and deliverables. Collaborates with health plan quality leads to strategically plan for supplemental data source (SDS) acquisition from providers and Electronic Medical Record (EMR) access. Oversees HEDIS-related training, vendor chart collection, invoice efforts, and SDS and EMR implementations.
Essential Job Duties
• Plans and/or implements operational processes for HEDIS operations that meet state and federal reporting requirements/rules, aligned with effective practices as identified in health care quality improvement literature and Molina health plans.
• Develops and implements targeted collection of clinical data acquisition related to performance reporting and improvement, including member and provider outreach.
• Serves as a subject matter expert (SME) for Molina health plan quality improvement HEDIS operations using a defined roadmap, timeline and key performance indicators (KPIs).
• Collaborates with the national intervention collaborative analytics and strategic teams to deliver value for both prospective and retrospective programs.
• Communicates with health plan senior leadership teams, national intervention teams and strategic teams on key deliverables, timelines, barriers and escalated issues that need immediate attention.
• Presents concise summaries, key takeaways and action steps related to Molina HEDIS processes, strategy and progress at national, regional and plan meetings.
• Demonstrates ability to lead and influence cross-functional teams that oversee implementation of quality projects.
• Leverages deep knowledge in quality to implement effective initiatives that drive change.
• Oversees clinical chart review/abstraction; includes qualitative analysis, reporting and development of program materials, templates or policies, and productivity reporting.
• Maintains advanced ability to collaborate and manage production vendor relationships, including oversight, data-driven key performance indicators (KPIs) measurement and performance mitigation strategies.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality/department-specific goals.
Required Qualifications
• At least 8 years of experience in managed care quality, including at least 4 years in health plan quality or process improvement, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates
• Advanced experience with HEDIS programs.
• Technical experience in reporting and/or programming.
• Advanced data analysis, manipulation and interpretation experience.
• Critical-thinking and problem-solving skills.
• Attention to detail and organizational/time-management skills.
• Ability to work in a cross-functional highly matrixed environment.
• Excellent verbal/written communication, and presentation skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.
Preferred Qualifications
• Medicare STAR program/CAHPS improvement experience.
• Experience with member/provider (HEDIS) outreach and/or quality intervention/improvement studies (development, implementation, evaluation).
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, licensed must be active and unrestricted in state of practice.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V