AVP, Clinical Stars & Quality Improvement (Remote)
Job Description
Job Summary This role oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs supporting Medicare Star Ratings improvement for Clinical HEDIS measures. Responsible for planning, developing and directing the implementation of improvement strategies to ensure high level of performance across Medicare Stars clinical HEDIS programs. Leads enterprise partnership discussions and improvement opportunities across matrix teams and health plans. This role is responsible for ensuring maintenance of programs for members in accordance with prescribed quality standards and provides direction and implementation of key clinical Stars strategies to support program regulations. Job Duties The Associate Vice President is a key Clinical Stars & Quality Improvement (QI) leader within the organization enterprise-wide. This position advises senior management, other corporate departments, and Molina health plans on Medicare Stars clinical strategies and initiatives and performs oversight over critical Medicare Stars functions occurring in our Medicaid health plans.
- Works with senior executives, Vice Presidents and others across Molina Healthcare (within Molina Plans and within various corporate departments) to set and achieve quality goals.
- Escalates gaps and barriers in implementation and compliance to SVP, Clinical Operations and CMO, Enterprise Medicare Unit,
- Develops strategic direction for Star Rating improvement through ongoing execution and program standardization for Clinical HEDIS stars measures.
- Collaborates and facilitates activities with other units at Corporate and within Molina State plans for intervention development and execution to support Medicare Stars measure level improvement and program revenue maximization across all key categories of the Stars Program
- Sets direction for Stars program activities with department leadership including leading corporate Stars initiative that require timely follow-up, tracking and communication on an on-going basis.
- as appropriate.
- Serves as a subject matter expert and represents the Clinical department in meetings and discussions Related to the the Clinical HEDIS pod for Stars management.
- Collaborates and facilitates activities with other units at corporate and Molina Plans.
- Identifies new QI requirements and builds out processes in advance of effective dates
Job Qualifications REQUIRED EDUCATION: Bachelor's Degree in a related field (Healthcare Administration, Public Health, or equivalent experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
- Clinical experience from clin ops role
- Minimum of 10 years relevant experience, including at least 5 years in health plan quality improvement.
- 5 years Medicaid/ Medicare experience.
- Minimum 3 years people management experience
- Demonstrated knowledge of and experience with Star Rating & Quality Improvement programs.
- Proficiency with data manipulation and interpretation.
- Proficiency with Excel and Visio (flow chart equivalent) and demonstrated ability to learn new information systems and software programs.
PREFERRED EXPERIENCE:
- Clinical Performance improvement and change management experience
- CAHPS improvement experience
- Stars improvement experience
- Experience with clinical intervention concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
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.