National Quality Performance Manager - HEDIS (Remote)

Molina Healthcare; United States; Remote; USD 90,000 - 130,000; Full time

Job summary

Molina Healthcare is seeking a skilled quality data program manager to lead data collection strategy, analytics, and reporting for quality outcomes across plans, including HEDIS readiness and health equity initiatives.

The role requires at least 3 years of program or project management in quality, healthcare experience, strong analytical and communication skills, and proficiency with Excel and data tools. You will collaborate across functions to sustain data quality and regulatory compliance.

Qualifications

• 3+ years of PM experience in quality
• Health care experience or knowledge of quality concepts
• Strong data analysis, reporting, and interpretation skills
• Proficiency with Excel and Microsoft Office
• Attention to detail and organizational skills
• Ability to work across a highly matrixed organization
• Effective verbal and written communication skills
• Willingness to learn new software tools

Responsibilities

• Collaborates with health plan quality leaders to manage quality data collection strategy, analytics, and reporting for quality metrics and outcomes.
• Monitors quality-related projects from inception through successful delivery.
• Oversees quality data ingestion through data validation and documentation to improve EHR/HIE data quality.
• Analyzes quality data to identify potential performance improvement opportunities.
• Ensures compliance with quality audit guidelines and HEDIS readiness.
• Partners with cross-functional teams to ensure data quality delivery through transformations.
• Creates and updates quality program documentation and ensures access for quality teams.
• Proactively communicates regular quality-related status reports to stakeholders, highlighting risks and issues.
• Meets customer expectations and maintains effective relationships.

Skills

Program management

Quality

Healthcare experience

Data analysis

Excel

Attention to detail

Cross-functional collaboration

Communication skills

Learning new software

Tools

SQL

Job description

JOB DESCRIPTION Job Summary

Essential Job Duties

• Collaborates with health plan quality leaders to improve outcomes by managing quality data collection strategy, analytics, and reporting for the following: quality rate trending and forecasting, provider quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement.
• Monitors quality-related projects from inception through successful delivery.
• Oversees quality data ingestion activities through data validation, issue identification, and documentation to improve completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact.
• Analyzes quality data and identifies potential performance improvement opportunities.
• 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 and identifies opportunities to close quality care gaps.
• Creates, reviews, and updates quality-related program documentation, including plans, reports, and records, and ensures information is accessible for quality teams throughout the enterprise.
• Proactively communicates regular quality-related status reports to stakeholders, highlighting progress, risks, and issues.
• Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.

Required Qualifications

• At least 3 years of program/project management experience in quality, or equivalent combination of relevant education and experience.
• Health care experience or demonstrated functional quality knowledge.
• 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.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Effective 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

• Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server.
• Intermediate 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.
• Knowledge of health care claim elements: 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 working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
• 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