Job Description

Job Summary

Serves as a people and functional area leader of all NCQA (National Committee of Quality Assurance) Accreditations, certifications, quality improvement compliance activities. Oversees the completion of national quality program management activities that support all facets of NCQA Accreditation and certification requirements . Responsible for understanding agency expectations applied to Medicare, Marketplace and Medicaid program oversight to ensure all areas are compliant with federal and state regulations along with NCQA accreditation requirements.

Job Duties

The AVP, Accreditation & Compliance leads NCQA Accreditation and Certification program management and oversees ongoing compliance to all requirements. Key activities include:

• Acts as the leadership contact to Molina health plans about key accreditation and certification program management topics, that include all of the following activities: organizational compliance to all standards and requirements to application surveys and certifications as established by NCQA or other regulators, management reporting, Medicaid, Marketplace, and Medicare audits and ongoing monitoring, NCQA accreditation, file review audit results and ongoing monitoring for NCQA and other regulatory requirements, policy and procedure development, auditing and follow up, , member and provider satisfaction survey development, fielding, vendor management and analysis, supporting new business development/RFP decision making related to accreditation and certification process, rules and implementation timelines.

• Oversees, prepares for, and participates in and/or facilitates national committees and workgroups in addition to support health plan committees and workgroups with meeting facilitation, report completion and presentation, and action plan development and monitoring.

• Oversees the national staff who implements accreditation activities that include, but are not limited to: report development and committee presentation, file review, ongoing monitoring and follow up, survey submission, and follow up with NCQA.

• Creates and monitors compliance metrics and presentations that show status of national QI compliance activities related to accreditation

• Communicates with Plan Presidents, Molina Leadership Teams, Chief Medical Officers, and VPs, Healthcare Services about key deliverables, timelines, barriers and escalated issues that need immediate attention through focused meetings, memos, and other methods.

• Collaborates with MHI HEDIS Operations to provide HEDIS results and other quality information for quality program documentation and reports.

• Presents summaries, key takeaways and action steps about Molina quality strategy to national, regional and plan meetings (internal and external) related to accreditation.

• Attends national Molina and local health plan meetings and with external stakeholders to represent quality where applicable and supportive of accreditation efforts.

Job Qualifications

REQUIRED EDUCATION :

Master’s Degree or equivalent.

Deep knowledge of quality including metrics, compliance requirements, and performance standards.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• Minimum 10 years experience in quality compliance, accreditation, quality program management, in a managed care setting with leadership level experience (e.g. supervisory experience, project management and team building experience), and compliance experience, within a national or local health plan or national organization.

• Demonstrated ability to lead and influence cross-functional teams that oversee implementation of quality improvement compliance activities.

• Strong knowledge in quality in order to implement activities and reporting that meets QI compliance requirements that drive change.

• Project management experience in a managed healthcare setting

PREFERRED EXPERIENCE :

• 10+ years experience in health plan quality improvement compliance.

• 7+ years experience in quality leadership role with a health plan or other related national organization with experience in all lines of business.

• 5+ years experience in quality accreditation management and activities

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: $122,430 - $238,739 / ANNUAL

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