Program Director, Quality Improvement (Remote)

JOB DESCRIPTION Job Summary Provides deep subject matter expertise and leadership for quality improvement (QI) activities. Responsible for new and existing health care 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 National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state QI compliance activities.

Essential Job Duties • Leads quality programs/projects in one or more of the following critical QI functional areas: Healthcare Effectiveness Data and Information Set (HEDIS) performance measurement (includes conducting data collection, reporting and monitoring for key performance measurement (KPI) activities), quality reporting, oversight of automated quality software tools and processes, clinical quality interventions, implementation and monitoring of the success of QI activities, and QI compliance, which provides the strategic direction and implementation of corporate and/or Molina plan National Committee for Quality Assurance (NCQA) accreditation surveys and federal and state QI compliance activities. • Serves as a quality improvement (QI) subject matter expert and leads quality programs to meet critical quality needs; advises senior leaders and other functions and departments on quality strategies and initiatives. • In collaboration with senior quality leadership, manages QI programs and interventions. • Collaborates and facilitates QI activities in collaboration with corporate functions and state health plans. • Leads corporate quality initiatives - ensures timely follow-up, tracking and communications with applicable stakeholders. • Communicates with and escalates gaps and barriers in QI implementation and compliance to department leadership, including proposed resolution. • Monitors and tracks key quality indicators, programs and initiatives to reflect the value and effectiveness of QI programs. • Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll-out). • Collaborates cross-functionally to identify areas and strategies for improved reporting and use of quality reporting tools. • Leads key clinical intervention activities including implementation of national and state-based quality interventions. • Collaborates cross-functionally to ensure that interventions are communicated, monitored and reported on a timely basis to demonstrate program effectiveness. • Facilitates and builds high-quality clinical care/services through relationships with key departments. • Leads Healthcare Effectiveness Data Information Set (HEDIS) performance measurement programs - leveraging knowledge, skills and technical expertise in performance measurement, data collection and reporting. • Provides training and support to new and existing quality team members.

Required Qualifications • At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance, or equivalent combination of relevant education and experience. • At least 3 years management/leadership experience. • Deep knowledge of the quality discipline, including metrics and performance standards. • Advanced knowledge and understanding of HEDIS/NCQA, including NCQA accreditation experience. • Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience. • Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience. • Medicare Stars program experience. • Experience with government-sponsored programs (Medicaid, Medicare, Marketplace). • Experience developing performance measures that support business objectives. • State quality