Lead Overreader, HEDIS/Quality Improvement (Remote)
Molina Healthcare Arizona; Las Cruces, New Mexico; New York, New York; Yonkers, New York; Cleveland, Ohio; Houston, Texas; San Antonio, Texas; Tacoma, Washington; St. Petersburg, Florida; Atlanta, Georgia; Columbus, Georgia; Macon, Georgia; Nampa, Idaho; Cedar Rapids, Iowa; Louisville, Kentucky; Grand Island, Nebraska; Wisconsin; Dallas, Texas; Fort Worth, Texas; Provo, Utah; Scottsdale, Arizona; Idaho Falls, Idaho; Davenport, Iowa; Sioux City, Iowa; Iowa City, Iowa; Ann Arbor, Michigan; Albuquerque, New Mexico; Michigan; Nebraska; New York; Akron, Ohio; Long Beach, California; Los Angeles, California; Flagstaff, Arizona; Riverside, California; San Bernardino, California; Chandler, Arizona; Laveen, Arizona; Bellevue, Washington; Madison, Wisconsin; Jacksonville, Florida; Detroit, Michigan; Florida; Layton, Utah; Racine, Wisconsin; Miami, Florida; Augusta, Georgia; Meridian, Idaho; Des Moines, Iowa; Owensboro, Kentucky; Covington, Kentucky; Sterling Heights, Michigan; Idaho; Iowa; Washington; Rio Rancho, New Mexico; Orem, Utah; Spokane, Washington; Green Bay, Wisconsin; Orlando, Florida; Warren, Michigan; Ohio; Buffalo, New York; Columbus, Ohio; Salt Lake City, Utah; Dayton, Ohio; Seattle, Washington; Boise, Idaho; Lexington-Fayette, Kentucky; Grand Rapids, Michigan; Lincoln, Nebraska; Kearney, Nebraska; Georgia; Santa Fe, New Mexico; Roswell, New Mexico; Rochester, New York; Syracuse, New York; Cincinnati, Ohio; Tucson, Arizona; Bowling Green, Kentucky; Omaha, Nebraska; Kentucky; New Mexico; Texas; Austin, Texas; West Valley City, Utah; Vancouver, Washington; Milwaukee, Wisconsin; Kenosha, Wisconsin; Phoenix, Arizona; Mesa, Arizona; Tampa, Florida; Savannah, Georgia; Caldwell, Idaho; Bellevue, Nebraska; Utah Job ID 2029792
Job Summary
Molina's Quality Improvement Lead Overreader conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The Lead Overreader meets chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills, as well as oversee the overread team to ensure they are on track to meet standards as well. Lead Overreader mentors and trains new team members. Leads special HEDIS/Quality projects.
Job Duties
- Performs the lead role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project, the Lead Overreader will act as the subject matter expert for the team.
- Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review.
- Assists Manager and Supervisor(s) in leading the training and mentoring of new staff and takes the lead role in these activities, utilizing the standardized training materials and job aids.
- Lead the team during HEDIS audits as well as ad hoc projects.
- Leads the scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
- Works with the Manager to monitor accuracy of abstracted records as required by specifications.
- Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
- Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.
- Provides data collection, presentations and report development support for quality improvement studies and performance improvement projects.
Job Qualifications
REQUIRED EDUCATION:
Bachelor's degree or equivalent experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 5 years experience in healthcare Quality/HEDIS specific to overreading
PREFERRED EXPERIENCE:
- At least 3 years of experience in the overread role.
- 3+ years managed care experience.
- Advanced knowledge of HEDIS and NCQA.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Active RN license for the State(s) of employment
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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: $30.37 - $61.79 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 01/16/2025ABOUT OUR LOCATION
View Map- Care Review Clinician, Inpatient Review (LPN/LVN) California California 02/28/2025
- Sr Investigator, SIU (Remote CT) Arizona, Hartford Connecticut, Dayton Ohio, Fort Worth Texas, Utah, Tacoma Washington, Bellevue Washington, Washington, Santa Fe New Mexico, Syracuse New York, Rochester New York, New York New York, Idaho, Omaha Nebraska, Bellevue Nebraska, Grand Island Nebraska, Rio Rancho New Mexico, Tampa Florida, Orlando Florida, St. Petersburg Florida, Kenosha Wisconsin, Cleveland Ohio, Ohio, Salt Lake City Utah, Layton Utah, Spokane Washington, Columbus Georgia, Iowa City Iowa, Albuquerque New Mexico, Florida, Akron Ohio, Provo Utah, Lexington-Fayette Kentucky, Grand Rapids Michigan, Michigan, Ann Arbor Michigan, Nebraska, Roswell New Mexico, Mesa Arizona, Houston Texas, Dallas Texas, Wisconsin, Georgia, Savannah Georgia, Yonkers New York, Boise Idaho, Buffalo New York, Des Moines Iowa, Caldwell Idaho, Kentucky, Bowling Green Kentucky, Phoenix Arizona, Racine Wisconsin, Austin Texas, Madison Wisconsin, Davenport Iowa, Meridian Idaho, Louisville Kentucky, Owensboro Kentucky, New Mexico, Jacksonville Florida, Atlanta Georgia, Texas, Green Bay Wisconsin, Sioux City Iowa, Columbus Ohio, Orem Utah, Macon Georgia, Cedar Rapids Iowa, New York, Nampa Idaho, Covington Kentucky, Sterling Heights Michigan, Detroit Michigan, Lincoln Nebraska, Las Cruces New Mexico, Chandler Arizona, Tucson Arizona, Miami Florida, Milwaukee Wisconsin, Cincinnati Ohio, San Antonio Texas, West Valley City Utah, Vancouver Washington, Seattle Washington, Augusta Georgia, Iowa, Idaho Falls Idaho, Warren Michigan, Kearney Nebraska, Scottsdale Arizona 02/21/2025
- Remote Program Manager, HCS - RN or Licensed Behavioral Health Professional Arizona, Lincoln Nebraska, Nebraska, Yonkers New York, Utah, Tacoma Washington, Spokane Washington, Kenosha Wisconsin, Wisconsin, Santa Fe New Mexico, Las Cruces New Mexico, Phoenix Arizona, Atlanta Georgia, Des Moines Iowa, Idaho Falls Idaho, Kentucky, Roswell New Mexico, Austin Texas, Jacksonville Florida, Macon Georgia, Davenport Iowa, Nampa Idaho, Warren Michigan, Buffalo New York, Provo Utah, Washington, Bellevue Washington, Racine Wisconsin, New Mexico, Tucson Arizona, Chandler Arizona, St. Petersburg Florida, Augusta Georgia, Georgia, Savannah Georgia, Iowa City Iowa, Idaho, Sterling Heights Michigan, Detroit Michigan, Vancouver Washington, Albuquerque New Mexico, Cleveland Ohio, Mesa Arizona, Tampa Florida, Miami Florida, Sioux City Iowa, New York, Syracuse New York, Layton Utah, Orem Utah, West Valley City Utah, Salt Lake City Utah, Seattle Washington, Ohio, Covington Kentucky, Lexington-Fayette Kentucky, Kearney Nebraska, Bellevue Nebraska, Rochester New York, Cincinnati Ohio, Akron Ohio, Rio Rancho New Mexico, Florida, Orlando Florida, Columbus Georgia, Boise Idaho, Owensboro Kentucky, Grand Rapids Michigan, Michigan, Ann Arbor Michigan, Grand Island Nebraska, Omaha Nebraska, Green Bay Wisconsin, Milwaukee Wisconsin, Columbus Ohio, Dayton Ohio, Cedar Rapids Iowa, Meridian Idaho, Louisville Kentucky, Bowling Green Kentucky, Dallas Texas, Houston Texas, San Antonio Texas, Texas, Madison Wisconsin, New York New York, Fort Worth Texas, Scottsdale Arizona, Iowa, Caldwell Idaho 02/28/2025
- Program Manager, Rural Health (Remote in Iowa) Iowa, Iowa City Iowa, Davenport Iowa, Cedar Rapids Iowa, Des Moines Iowa, Sioux City Iowa 02/24/2025