Director, National Risk & Quality Solutions

Molina Healthcare; Northern (KY); Hybrid; USD 80,000 - 160,000; Full time

Job summary

Molina Healthcare seeks a subject matter expert to provide enterprise risk and quality solutions (RQS) support and leadership. You will collaborate with health plan leaders to implement best practices, ensuring action plans meet risk and quality performance goals.

You will lead risk/quality programs, escalate barriers, and develop business case methodologies. You will coordinate activities with corporate and health plan teams to drive improvements across the organization.

Qualifications

• At least 8 years of managed care experience, including risk adjustment/quality-related experience.
• At least 3 years of management/leadership experience.
• Proficiency with risk adjustment methodologies.
• Quality/risk operational and process improvement experience.
• Proficiency with data analysis, manipulation and interpretation.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Ability to collaborate and drive/influence change and initiatives with internal/external stakeholders.
• Project management experience.
• Excellent verbal/written communication skills, and presentation skills.
• Microsoft Office suite and applicable software programs proficiency.

Responsibilities

• Provides risk and quality support to a selection of state health plans using RQS best practices.
• Leads risk/quality-related programs to meet critical needs.
• Escalates gaps and barriers to leadership and partners with the execution team for resolution.
• Represents a consultative role, developing business case methodologies for incremental programs.
• Collaborates with corporate and health plan teams on risk/quality activities.

Skills

Managed care experience

Risk adjustment

Quality improvement

Data analysis

Project management

Leadership

Communication skills

MS Office proficiency

Tools

MS Office

Job description

Molina Healthcare seeks a subject matter expert to provide enterprise risk and quality solutions (RQS) support and leadership. You will collaborate with health plan leaders to implement best practices, ensuring action plans meet risk and quality performance goals.

You will lead risk/quality programs, escalate barriers, and develop business case methodologies. You will coordinate activities with corporate and health plan teams to drive improvements across the organization.