National Quality Performance Leader

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

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.