Remote Utilization Review Rn Jobs in Corvallis, OR

Job Listing ID: 4102623
Job Title: Specialist, Quality Interventions/QI Compliance (Remote)
Application Deadline: Open Until Filled
Job Location: Salem
Date Posted: 08/31/2024
Hours Worked Per Week: Not Provided
Shift: Not Provided
Duration of Job: Either Full or Part Time, more than 6 months
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Job Summary:
JOB DESCRIPTION
Job Summary
Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare 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 NCQA accreditation surveys and federal/state QI compliance activities.
Only candidates with previous experience in health care quality/HEDIS, report writing and leadership presentation.
KNOWLEDGE/SKILLS/ABILITIES
The Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.
Health Plan experience across lines of business (Medicaid/Marketplace).
Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.
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.
Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.
Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.
Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.
Evaluates project/program activities and results to identify opportunities for improvement.
Surfaces to Manager and Director any gaps in processes that may require remediation.
Other tasks, duties, projects, and programs as assigned.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and work experience.
Required Experience
Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.
Demonstrated solid business writing experience.
Operational knowledge and experience with Excel and Visio (flow chart equivalent).
Preferred Education
Preferred field: Clinical Quality, Public Health or Healthcare.
Preferred Experience
1 year of experience in Medicaid/Marketplace.
Preferred License, Certification, Association
Certified Professional in Health Quality (CPHQ)
Nursing License (RN may be preferred for specific roles)
Certified HEDIS Compliance Auditor (CHCA)
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: $21.82 - $42.55 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Classification: Business Operations Specialists, All Other
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Compensation
Salary: Not Provided
Job Requirements
Experience Required: See Job Summary
Education Required: None
Minimum Age: N/A
Gender: N/A