Specialist, Quality Management - Audit Coordination (Remote in Arizona)
Job Description
Job Summary Molinas Quality Management function implements, oversees, and maintains new and existing healthcare quality monitoring activities and programs; ensures quality monitoring audits and investigations are performed in accordance with prescribed quality standards; informs data collection, reporting, and analysis to monitor key quality management activity; and provides direction and implementation of federal/state quality management compliance activities. Please make sure to include any healthcare/HEDIS/quality metric experience on your resume. We are moving quickly to fill this position. Job Duties The Specialist, Quality Management contributes to the quality management functions. Facilitates individual and systemic quality of care investigations. Monitors and evaluates the structure and processes for tracking and trending reportable incidents, quality of care events, member service concerns, and mortalities. Organizes and manages quality monitoring activities, including audits of medical record quality, services and service sites, health and safety, and follow-up of monitoring of placement settings. Creates, manages, and leads quality management activities, meetings, and discussions with and between other departments within the organization. Evaluates project/program activities and results to identify opportunities for improvement. Monitors and collaborates with Manager and Director to address any gaps in processes that may require remediation. Creates and implements written documentation and business practices (e.g., policies and procedures, desk-level procedures, manuals, and process flows) that explain the business requirements and how the unit operationalizes those requirements. Maintains the creation and ongoing revision of policies and procedures reflective of state requirements for all quality management functions, including quality monitoring audits, credentialing and recredentialing, quality of care concerns, and peer review. Is well-versed in the requirements of the quality management program and day-to-day work processes to support compliance with state contract, policies, and program requirements. Job Qualifications REQUIRED EDUCATION: Bachelor's Degree or equivalent combination of education and work experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: Min. 3 years experience in healthcare with 1 year experience in health plan quality improvement, managed care or equivalent experience. Demonstrated experience with Quality, HEDIS, RA or equivalent. Demonstrated solid business writing experience. Proficient in Microsoft Office tools (Outlook, Excel, Visio, etc.) PREFERRED EDUCATION: Preferred field: Clinical Quality, Public Health, or Healthcare. PREFERRED EXPERIENCE: 2 years project coordination experience. Ability to work across all levels of the organization, including working with executive audiences, vendors, providers, and the government as a customer. Assisting with Audits: Compliance Behavioral health Qualitative reviews of records Pediatrics, primary care. Quality of care investigations. Providers, sending audit notification. Working closely with nurses. Presentation skills. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Certified Professional in Health Quality (CPHQ) Nursing License (RN may be preferred for specific roles) PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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: $49,930 - $97,363 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Apply Job!