Job Description
Job Summary
Leads and manages Quality Systems performance managers, demonstrating accountability for people performance, delivery outcomes, and execution of quality system initiatives. Oversees a portfolio of quality data and performance improvement activities, ensuring teams are resourced, aligned, and operating in accordance with quality strategies, regulatory requirements, and enterprise priorities.
Job Duties
Manages the Quality Systems team, including setting expectations, monitoring performance, providing coaching and feedback, and ensuring alignment with quality strategies and department specific goals.
Supports the annual quality data submission process, including National Committee for Quality Assurance (NCQA) and state regulatory submissions.
Manages, designs, and develops data-focused strategies to improve completeness and accuracy of data ingestion activities including supplemental and Health Information Exchange (HIE) data.
Collaborates with corporate quality leaders and health plans to improve program performance by supporting development of meaningful reporting and analytics including but not limited to: quality rate trending and forecasting, provider quality performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other survey analytics, and health equity.
Oversees development of quality project plans and schedules, assigns resources, and ensures deliverables are met on time, within scope, and in compliance with regulatory requirements.
Identifies potential barriers to quality project plans and develops mitigation strategies.
Ensures complex problems are addressed and resolved by the team through effective prioritization, escalation, and cross-functional collaboration.
Draws actionable conclusions and collaborates with cross-functional teams to present recommendations/solutions to identify quality issues.
Conducts regular quality-related reviews and audits to maintain high standards of performance.
Addresses issues/discrepancies promptly to ensure quality program success.
Develops data quality strategies and solutions to close quality care gaps.
Communicates effectively and consistently with leadership and key stakeholders regarding portfolio status, risks, dependencies, and recommended remediation approaches.
Fosters a collaborative and high-performing team and promotes professional development and knowledge sharing within the team.
Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality department-specific goals.
Job Qualifications
REQUIRED QUALIFICATIONS:
At least 7 years of program/project management experience in quality, including experience supporting HEDIS activities targeting and reporting, or equivalent combination of relevant education and experience.
At least 1 year of management/leadership experience.
Comprehensive mastery of the drivers of value in managed health care, and in-depth knowledge of quality and the health care industry.
Extensive knowledge and mastery of the nuances of health care claim elements including: Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine - Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), National Provider Identifiers (NPIs), and Taxpayer Identification Numbers (TINs).
Experience running queries in Microsoft Azure or Structured Query Language (SQL) server.
Ability to assess impact cross-functionally, identify costs/benefits to upstream and downstream stakeholders, and solution benefits to multiple business areas.
Intellectual agility and ability to simplify and clearly communicate complex concepts.
Proficiency with data analysis, manipulation, interpretation, and reporting.
Strong quantitative aptitude, critical-thinking, problem-solving, and analytical skills.
High attention to detail and organizational skills.
History of partnering with various levels of leadership across complex organizations, and ability to work cross-collaboratively in a highly matrixed organization.
Strong verbal, written and presentation communication skills.
Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs.
PREFERRED QUALIFICATIONS:
Experience leading in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
History of excelling in roles impacting quality.
Advanced knowledge/experience related to National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS), and state-specific regulatory submission requirements.
Microsoft Azure Databricks and SQL mastery.
Project Management Professional (PMP).
Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.
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.
Molina Healthcare is a managed care organization that provides health insurance and care management services, primarily serving Medicaid members. The company operates health plans and delivers integrated care coordination across the continuum of care, combining medical management with behavioral health, long-term services and supports (LTSS), and community resources. Molina employs advanced claims processing systems, risk adjustment methodologies, and quality performance management to ensure cost-effective, high-quality member outcomes. The company supports various health plans and regulatory requirements while managing complex operations including provider contracting, benefits configuration, and HEDIS audit compliance.
