National Quality Performance Manager (Remote)

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

Job summary

Molina Healthcare is seeking a qualified professional to join our team to manage quality data collection strategies, analytics, and reporting across programs. This role focuses on improving outcomes by monitoring data, validating data ingestion, and ensuring alignment with regulatory audit requirements.

The position requires strong data analysis, reporting skills, and the ability to navigate a highly matrixed organization.

Qualifications

• Minimum 3 years of program/project management experience in quality or equivalent.
• Healthcare quality knowledge or experience is preferred.
• Ability to simplify complex concepts and communicate clearly.
• Proficient data analysis, manipulation, interpretation and reporting.
• Strong quantitative and problem-solving skills.
• Attention to detail and organizational skills.
• Experience working in a matrixed organization and cross-functional teams.
• Strong written and verbal presentation abilities.
• Proficiency with MS Office and related software.

Responsibilities

• Collaborates with health plan quality leaders on data collection strategy, analytics, and reporting.
• Monitors quality data projects from inception to delivery.
• Oversees data ingestion with validation and documentation for EHR/HIE data.
• Analyzes data to identify performance improvement opportunities.
• Ensures compliance with quality regulatory audit guidelines and timelines.
• Partners with cross-functional teams to ensure data quality delivery.
• Creates and maintains quality program documents and reports.
• Communicates regular quality status reports to stakeholders.
• Meets customer expectations and builds trust with teams.

Skills

Project management

Data analysis

Communication

SQL familiarity

MS Office

Cross-functional collaboration

Attention to detail

Regulatory awareness

Problem solving

Reporting

Tools

SQL Server

Azure (basic)

Excel

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