JOB TITLE: Sr. Specialist, Quality Improvement RN (REGISTERED NURSE)For this position we prefer someone with 5 - 7 years hospital clinical experience and prior managed care. It will be very important to have excellent professional writing skills, and solid critical thinking skills.Must have RN licensure, unrestricted.WORK SCHEDULE: Normal business hours in your local time zone ( 8:00AM to 5:00PM) availability to flex to accommodate projects / meetings in other time zones. Some holidays and weekends may be required. Please consider these parameters before applying to this position.This is a remote based position, and you can work from home.JOB DESCRIPTIONJob SummaryMolina'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/ABILITIESThe Senior Specialist, Quality Improvement (Registered Nurse) contributes to one or more of these quality improvements functions: Quality Interventions, Quality Improvement Compliance, HEDIS, and / or Quality Reporting.Quality Intervention / QI 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 that require a component of near real-time clinical decision-making. These activities may include initiation and management of interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; preparation and review of potential quality of care and critical incident cases; review of medical record documentation for credentialing and model of care oversight; and any other federal and state required quality activities.
Monitors and ensures that key quality activities that involve clinical decision-making 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 that have a component of clinical decision-making.
Leads quality improvement activities, meetings, and discussions with and between other departments within the organization. Often the Senior Specialist will be assigned activities where clinical expertise is important to the activity.
Surfaces to Manager and Director any gaps in processes that may require remediation. In particular, the Senior Specialist may be asked to focus on parts of the process where a clinician's perspective would be valuable to uncover process gaps or limitations.
JOB QUALIFICATIONSRequired EducationBachelor's degree in nursing or higherRequired ExperienceMin. 3 years’ experience in healthcare with minimum 2 years’ experience in health plan quality improvement, managed care, or equivalent experience.Required License, Certification, AssociationActive and unrestricted RN license for the State(s) of employmentPreferred EducationPreferred field: Clinical Quality, Public Health or Healthcare. Nursing: Master's or higherPreferred Experience
2 years coding and medical record abstraction experience.
1-year managed care experience.
Basic knowledge of HEDIS and NCQA.
Preferred License, Certification, Association
Certified Professional in Health Quality (CPHQ)
Certified HEDIS Compliance Auditor (CHCA)
Registered Health Information Technician (RHIT), or
Certified Medical Record Technician with training in coding procedures (as required by state/location only), or
Certified Professional Coder (CPC)
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: $49,430.25 - $107,098.87 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.