JOB SUMMARY:

The Senior Specialist, Quality Program Management & Performance RNensures 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. Supports the creation and ongoing revision of policies and procedures that reflect state requirements for all quality management functions. In accordance with state-based requirements, ensures quality of care investigations are performed timely and accurately. Field travel is required.

ESSENTIAL JOB DUTIES:

Ensures individual and systemic quality of care investigations are performed timely, accurately, and in accordance with state-based requirements

Adheres to structure and processes for tracking and trending reportable incidents, quality of care events, member service concerns, and mortalities

Performs quality monitoring activities, including audits of medical record quality, services, and service sites, health and safety, and follow-up of monitoring of placement settings

Monitors and ensures that key quality activities that involve clinical decision-making are completed on time and accurately to present results to key departmental management and other Molina departments as needed

Implements key quality strategies that require a component of near real-time clinical decision-making. These activities may include preparation and review of potential quality of care and critical incident cases (as applicable)

Adheres to 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

Supports the creation and ongoing revision of policies and procedures that reflect state requirements for all quality management functions, including quality monitoring audits, credentialing and re-credentialing, quality of care concerns, and peer review

Well-versed in the requirements of the quality program and day-to-day work processes to support compliance with state contracts, policies, and program requirements

Evaluates project/program activities and results to identify opportunities for improvement

Surfaces to the 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

Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed

This position may require same-day out-of-office travel approximately 0 - 50% of the time, depending on the location.

This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

REQUIRED QUALIFICATIONS:

Bachelor's Degree or equivalent combination of education and work experience.

Min. 3 years’ experience in healthcare with a minimum of 1 year’s experience in quality management and clinical quality investigations, or equivalent experience

Critical thinking skills

Strong communication skills, both verbally and written

Ability to interact effectively with health plan clinical leaders and peers across the organization

Proficient in Microsoft Office tools (Outlook, Excel, etc.) Communicates clearly and concisely and is able to tailor messaging to diverse audiences

Excellent problem-solving skills.

QM Nurse: Arizona-licensed RN or a Licensed Practical Nurse (LPN) with current Licensure under the Arizona State Board of Nursing (BON)

QM BH Nurse: Arizona-licensed registered nurse practitioner licensed as an adult, psychiatric and mental health nurse, or Arizona-licensed registered nurse with a psychiatric-mental health nursing certification, or one year of experience providing behavioral health services

PREFERRED QUALIFICATIONS:

Advanced degree in Nursing, Public Health, Health Administration, Social Work, or related field

2 years of medical record abstraction experience

1 year health plan quality management

Ability to work across all levels of the organization, including working with executive audiences, vendors, providers, and the government as a customer

Certified Professional in Health Quality (CPHQ)

QM Nurse:

• Arizona-licensed RN or a Licensed Practical Nurse (LPN) with current Licensure under the Arizona State Board of Nursing (BON)

QM BH Nurse:

• Arizona-licensed registered nurse practitioner licensed as an adult, psychiatric and mental health nurse, or

• Arizona-licensed registered nurse with:

a. A psychiatric-mental health nursing certification, or

b. One year of experience providing behavioral health services

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: $60,415 - $117,809 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.