National Quality Performance Manager - HEDIS (Remote)

Molina Healthcare’s National Quality Performance Manager provides subject matter expertise to its quality performance solutions team. The role coordinates enterprise stakeholders and resources to deliver quality data, analytics, reporting, regulatory audit readiness, and performance improvement initiatives.

Responsibilities

Collaborates with health plan quality leaders to improve outcomes by managing quality data collection strategy, analytics, and reporting for the following: quality rate trending and forecasting, provider quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement

Monitors quality-related projects from inception through successful delivery

Oversees quality data ingestion activities through data validation, issue identification, and documentation to improve completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact

Analyzes quality data and identifies potential performance improvement opportunities

Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines, and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success

Partners with cross-functional teams to ensure data quality delivery through sequential transformations and identifies opportunities to close quality care gaps

Creates, reviews, and updates quality-related program documentation, including plans, reports, and records, and ensures information is accessible for quality teams throughout the enterprise

Proactively communicates regular quality-related status reports to stakeholders, highlighting progress, risks, and issues

Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect

Preferred

Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server

Intermediate 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

Knowledge of health care claim elements: 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 working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs

Project Management Professional (PMP)

Six Sigma Green Belt or Black Belt certification, and/or comparable coursework

Microsoft Azure

SQL Server Querying

NCQA Knowledge

HEDIS Knowledge

CMS Knowledge

State Regulatory Submissions

CPT Coding

CPT Category II Coding

LOINC

SNOMED CT

HCPCS Coding

National Drug Codes

CVX Codes

National Provider Identifiers

Taxpayer Identification Numbers

Matrixed Organization Experience

Managed Care Experience

Medicaid Programs

Medicare Programs

Marketplace Programs

Six Sigma Green Belt

Six Sigma Black Belt

Six Sigma Coursework

Benefits

Remote work

Company

Government-sponsored health plans for families and individuals

Long Beach, California, USA

https://investors.molinahealthcare.com/

Founded in 1980

10001+ employees

Qualifications

At least 3 years of program/project management experience in quality, or equivalent combination of relevant education and experience

Health care experience or demonstrated functional quality knowledge

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

Attention to detail and organizational skills

Ability to work cross-collaboratively in a highly matrixed organization

Effective verbal, written and presentation communication skills

Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs

Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server

Intermediate 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

Knowledge of health care claim elements: 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 working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs

Project Management Professional (PMP)

Six Sigma Green Belt or Black Belt certification, and/or comparable coursework

At least 3 years of program/project management experience in quality, or equivalent combination of relevant education and experience.

Required skills

Represents the skills you have, click on the tags, Healthcare Quality, Program and Project Management, Microsoft Azure, SQL Server, NCQA Quality Standards, HEDIS, CMS Regulatory Requirements, Healthcare Coding Systems CPT, Healthcare Coding Systems CPT II, Healthcare Coding Systems LOINC, Healthcare Coding Systems SNOMED, Healthcare Coding Systems HCPCS, Healthcare Coding Systems NDC, Healthcare Coding Systems CVX, Project Management Professional (PMP), Six Sigma

Experience

3+ years