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Specialist, Quality Interventions/QI Compliance (Remote)
Specialist, Quality Interventions/QI Compliance (Remote)Utah Staffing • Orem, UT, US
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Specialist, Quality Interventions / QI Compliance (Remote)

Specialist, Quality Interventions / QI Compliance (Remote)

Utah Staffing • Orem, UT, US
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Quality Interventions Specialist

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

  • 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 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.

This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location. This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

Job Qualifications :

Required Education : Bachelors Degree or equivalent combination of education and work experience.

Required Experience :

  • Min. 3 years experience in healthcare with 1 year 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.
  • Preferred License, Certification, Association :

  • Certified Professional in Health Quality (CPHQ)
  • Nursing License (RN may be preferred for specific roles)
  • Certified HEDIS Compliance Auditor (CHCA)
  • Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $21.82 - $42.55 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.

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    Compliance Specialist • Orem, UT, US

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