Health Plan Quality & Risk Strategy Leader

Molina Healthcare; Nevada (IA); On-site; USD 122,430 - 238,739; Full time

Job summary

Molina Healthcare seeks an experienced leader to drive risk and quality strategy across its health plan operations in the United States. The role oversees plan risk, quality initiatives, and NCQA/Medicare Stars activities, coordinating with corporate teams and state agencies.

You will manage the local quality committees, align interventions with enterprise strategy, and ensure timely reporting, data collection and KPI monitoring to improve CAHPS, HEDIS and HOS scores.

Qualifications

• At least 10 years experience in quality improvement (QI)/compliance/HEDIS operations in a managed care setting.
• At least 5 years management/leadership experience.
• Advanced knowledge of the quality discipline, including metrics and performance standards.
• Knowledge and experience related to risk adjustment.
• Ability to think strategically, develop vision, and execute effectively for near and long-term results.
• Experience implementing effective quality interventions and performance measures.
• Experience educating network providers to develop quality improvements and value-based initiatives.
• Advanced knowledge of HEDIS, NCQA, CAPHS, and Medicare Stars.
• Proficiency with data analysis, manipulation, interpretation and reporting.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Responsibilities

• Provides strategy and leadership for health plan risk and quality activities.
• Leads local execution of quality improvement activities with defined KPIs.
• Collaborates with corporate teams to align quality strategy and interventions.
• Acts as primary contact to state agencies on risk and quality matters.
• Leads local health plan quality committees and required documentation for performance projects.
• Develops and sustains a high-performance team to support strategic objectives.
• Represents Molina in external forums and regional quality initiatives.
• Oversees data analytics for risk, quality, and contractual obligations.

Skills

Quality improvement

Leadership

Data analysis

Project management

Strategic thinking

Communication

Tools

Microsoft Office

Job description

Molina Healthcare seeks an experienced leader to drive risk and quality strategy across its health plan operations in the United States. The role oversees plan risk, quality initiatives, and NCQA/Medicare Stars activities, coordinating with corporate teams and state agencies.

You will manage the local quality committees, align interventions with enterprise strategy, and ensure timely reporting, data collection and KPI monitoring to improve CAHPS, HEDIS and HOS scores.