National Quality Performance Manager (Remote)

Molina Healthcare; Northern (KY); Hybrid; USD 60,000 - 130,000; Full time

Job summary

Molina Healthcare is seeking a qualified professional to lead quality performance initiatives across the enterprise. The role focuses on data collection strategy, analytics, reporting, and improvement of quality outcomes in collaboration with health plan leaders.

Responsibilities include overseeing data ingestion, ensuring data integrity in EHR/HIE systems, and driving improvement opportunities while maintaining regulatory compliance and strong stakeholder relationships.

Qualifications

• At least 3 years of program/project management experience in quality.
• Health care experience or demonstrated functional quality knowledge.
• Ability to simplify and clearly communicate complex concepts.
• Proficiency with data analysis, manipulation, interpretation, and reporting.
• Strong quantitative, 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 ability to learn/navigate new software programs.

Responsibilities

• Collaborates with health plan quality leaders to improve outcomes through data collection, analytics, and reporting for quality metrics.
• Monitors quality-related projects from inception through delivery.
• Oversees quality data ingestion activities to improve EHR/HIE data accuracy.
• Analyzes quality data and identifies improvement opportunities.
• Ensures compliance with regulatory audit guidelines to maximize HEDIS audit success.
• Partners with cross-functional teams to ensure data quality delivery.
• Creates and updates quality program documentation for enterprise access.
• Proactively communicates quality status to stakeholders, highlighting progress, risks and issues.
• Meets customer expectations and maintains strong relationships.

Skills

Program management

Quality improvement

Data analysis

Cross-functional collaboration

Communication skills

Microsoft Excel

Regulatory knowledge

Tools

SQL Server

Azure SQL

Job description

JOB DESCRIPTION

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.

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.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 - $129,589.63 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.