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 EDU C A TI O N:

Bachelor's degree or equivalent experience

REQUIRED EXPER I E N CE/KNOWLEDGE, SKILLS & ABILITIES:

• 5 years experience in healthcare Quality/HEDIS specific to overreading

PREFERRED EXPER I E N CE:

• At least 3 years of experience in the overread role.
• 3+ years managed care experience.
• Advanced knowledge of HEDIS and NCQA.

PREFERRED LI C E N SE, C ERTIFIC A T ION, ASSOC I A TI O N:

Active RN license for the State(s) of employment

PHYS I CAL DEMA NDS:

Working envir o nment is ge nerally fa vo rable and lighti ng and tem perature are adequate. W ork is generally perfo r med in an office e n vir o n ment in w hich t here is o n ly minimal exp osure to unpleasant and /or hazard o us w orking co nditio ns. M u st h a ve the ability to sit for lo ng perio ds. Reas o nable accom mo d atio ns m ay be made to e nable ind i viduals with disabilities to perf o rm t he essential functio n.

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.