National Quality Performance Manager- HEDIS / SQL (Remote)

Molina Healthcare; United States; Remote; USD 60,000 - 119,000; Full time

Job summary

Molina Healthcare is seeking a quality performance and data analytics professional to drive initiatives focused on HEDIS, CAHPS and SQL. You will collaborate with health plan quality leaders to improve outcomes, manage data strategies, and ensure compliance with regulatory guidelines.

The role emphasizes data validation, reporting, and partnership with cross-functional teams to deliver quality improvements and audit readiness across enterprise programs.

Qualifications

• 3+ years of program/project management experience in quality or equivalent
• Healthcare quality knowledge or experience preferred
• Strong analytical, communication, and organizational skills
• Proficiency with data analysis, manipulation, interpretation and reporting
• Ability to work cross-functionally in a matrixed organization

Responsibilities

• Lead quality data collection strategy, analytics and reporting for quality rate trending, provider quality measurement and CAHPS.
• Oversee quality data ingestion, validation, and documentation to improve EHR/HIE data accuracy.
• Identify performance improvement opportunities from quality data analysis.
• Ensure compliance with quality audit guidelines and improve HEDIS audit success.
• Collaborate with cross-functional teams to ensure data quality delivery and close care gaps.
• Create and maintain quality program documentation and reports.
• Provide regular status updates to stakeholders on progress, risks and issues.

Skills

Project management

Quality knowledge

Data analysis

SQL basics

Cross-functional collaboration

Communication

Excel proficiency

Education

PMP

Six Sigma Green Belt/Black Belt

Tools

Microsoft Office

Excel

Job description

Job Summary

Provides subject matter expertise for Molina's quality performance solutions team. Collaborates with various departments and stakeholders across the enterprise to plan, coordinate, and manage resources, and execute quality performance improvement initiatives in alignment with strategic objectives.

This position is focused on HEDIS, CAHPS and SQL. Please make sure to update your resume with any relevant experience.

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

Pay Range: $59,810.6 - $118,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.