Lead National Quality Performance Manager (Remote)

Molina Healthcare; United States; Remote; USD 72,000 - 157,000; Full time

Job summary

Molina Healthcare seeks a senior quality programs consultant to own and drive the most complex initiatives within the quality performance solutions team. You will partner with leadership to align with quality strategies, regulatory requirements, and enterprise priorities.

Responsibilities include leading complex data analyses, data ingestion oversight, and providing SME guidance while ensuring timely delivery and compliance with audits.

Qualifications

• At least 5 years of program/project management experience in quality, including experience supporting HEDIS activities and reporting.
• Comprehensive mastery of drivers of value in managed health care and quality in the health care industry.
• Extensive knowledge of health care claim elements (CPT, CPTII, LOINC, SNOMED, HCPCS, NDC, CVX, NPIs, TINs).
• Experience running queries in Microsoft Azure or SQL server.
• Ability to assess cross-functional impact and benefits to multiple business areas.
• Strong analytical, numerical, and problem-solving skills with attention to detail.
• Proficiency with Microsoft Office (including Excel) and ability to learn new software.

Responsibilities

• Leads execution of complex quality data analysis and reporting initiatives with health plan quality leaders and cross-functional partners.
• Ensures quality programs are delivered on time, within scope, and within resource constraints.
• Provides SME guidance for quality programs and projects, aiding design, planning, and resourcing with management.
• Oversees data ingestion activities and partners with technical teams to resolve data quality issues affecting EHR/HIE data.
• Acts as escalation point for complex quality issues and drives resolution through advanced data analysis and cross-functional collaboration.
• Drives program changes and provides regular progress updates, risks, and remediation recommendations to leadership.
• Proactively communicates quality issues to stakeholders and leadership.
• Draws actionable conclusions and recommends performance improvement initiatives.
• Ensures compliance with quality regulatory audit guidelines and supports HEDIS audit success.
• Partners with cross-functional teams to ensure data quality through transformations and to close quality care gaps.
• Maintains deliverables meeting all quality standards and regulatory requirements.
• Creates and reviews complex quality program documentation and validates before management approval.
• Communicates regular quality-related status reports to stakeholders with progress and remediation details.
• Represents the quality team SME and supports additional requests as needed.
• Provides training, mentoring, and knowledge sharing to quality team members on tools, processes, and best practices.
• Promotes collaboration within the quality team and contributes to a high-performing culture.

Skills

Program management

Quality management

Data analysis

Regulatory compliance

Communication

Leadership

SQL

Azure

Stakeholder management

Tools

SQL server

Microsoft Azure

Azure Databricks

Job description

Job Summary

Provides consultant level support for Molinas quality performance solutions team. Owns and drives the most complex quality performance initiatives, provides functional guidance to peers, and partners with leadership to ensure alignment with quality strategies, regulatory requirements, and enterprise priorities.

Job Duties

• Leads execution of complex quality data analysis and reporting initiatives, collaborating with health plan quality leaders and cross-functional partners to support quality rate trending, provider performance measurement, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH) initiatives, and external vendor engagement.
• Ensures quality programs are successfully delivered on time, within scope, and within resource constraints.
• Provides functional guidance and subject matter expertise for quality programs and projects, contributing to solution design, project planning, and identification of resource needs in partnership with management.
• Oversees execution of quality data ingestion activities and partners with technical teams to resolve complex data quality issues impacting electronic health record (EHR), health information exchange (HIE), and supplemental data.
• Serves as an escalation point for complex quality issues, driving resolution through advanced data analysis, project management, and cross-functional collaboration.
• Leads execution of complex quality assignments and program changes, ensuring alignment with program goals and providing regular updates to leadership on progress, risks, and recommendations.
• Proactively communicates quality issues to stakeholders and leadership.
• Draws actionable quality-related conclusions and recommends performance improvement initiatives.
• Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success.
• Partners with cross-functional teams to ensure data quality delivery through sequential transformations, draw actionable conclusions, and identify opportunities to close quality care gaps.
• Ensures that program deliverables meet all quality standards and regulatory requirements.
• Creates and reviews complex quality-related program documentation and provides input and validation prior to management approval.
• Proactively communicates regular quality-related status reports to stakeholders - highlighting progress issues, and recommended remediation.
• Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.
• Represents as quality team subject matter expert (SME); maintains flexibility to pivot and support other requests as needed.

Provides functional training, mentoring, and knowledge sharing to quality team members related to tools, processes, and best practices.

Promotes collaboration and knowledge sharing within the quality team and contributes to a high-performing team culture through functional leadership.

Job Qualifications

Required Qualifications

• At least 5 years of program/project management experience in quality, including experience supporting HEDIS activities, targeting and reporting, or equivalent combination of relevant education and experience.
• Comprehensive mastery of the drivers of value in managed health care, and in-depth knowledge of quality and the health care industry.
• Extensive knowledge and mastery of the nuances of health care claim elements including: Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine - Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), National Provider Identifiers (NPIs), and Taxpayer Identification Numbers (TINs).
• Experience running queries in Microsoft Azure or Structured Query Language (SQL) server.
• Ability to assess impact cross-functionally, identify costs/benefits to upstream and downstream stakeholders, and solution benefits to multiple business areas.
• Intellectual agility and ability to simplify and clearly communicate complex concepts.
• Proficiency with data analysis, manipulation, interpretation, and reporting.
• Strong quantitative aptitude, critical-thinking, problem-solving, and analytical skills.
• High attention to detail and organizational skills.
• History of partnering with various levels of leadership across complex organizations, and ability to work cross-collaboratively in a highly matrixed organization.
• Strong project management experience.
• Strong verbal, written and presentation communication skills.
• Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs.

Preferred Qualifications

• Experience leading in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
• History of excelling in roles impacting quality.
• Advanced knowledge/experience related to National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS), and state-specific regulatory submission requirements.
• Microsoft Azure Databricks and SQL mastery.
• Project Management Professional (PMP).
• Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $72,370.82 - $156,803.45 / ANNUAL

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