Program Director, National Risk & Quality Solutions (Remote)

Molina Healthcare; Northern (KY); Hybrid; USD 80,000 - 160,000; Full time

Job summary

Molina Healthcare seeks a subject matter expert to provide enterprise risk and quality solutions (RQS) support and leadership. You will collaborate with health plan leaders to implement best practices, ensuring action plans meet risk and quality performance goals.

You will lead risk/quality programs, escalate barriers, and develop business case methodologies. You will coordinate activities with corporate and health plan teams to drive improvements across the organization.

Qualifications

• At least 8 years of managed care experience, including risk adjustment/quality-related experience.
• At least 3 years of management/leadership experience.
• Proficiency with risk adjustment methodologies.
• Quality/risk operational and process improvement experience.
• Proficiency with data analysis, manipulation and interpretation.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Ability to collaborate and drive/influence change and initiatives with internal/external stakeholders.
• Project management experience.
• Excellent verbal/written communication skills, and presentation skills.
• Microsoft Office suite and applicable software programs proficiency.

Responsibilities

• Provides risk and quality support to a selection of state health plans using RQS best practices.
• Leads risk/quality-related programs to meet critical needs.
• Escalates gaps and barriers to leadership and partners with the execution team for resolution.
• Represents a consultative role, developing business case methodologies for incremental programs.
• Collaborates with corporate and health plan teams on risk/quality activities.

Skills

Managed care experience

Risk adjustment

Quality improvement

Data analysis

Project management

Leadership

Communication skills

MS Office proficiency

Tools

MS Office

Job description

Job Summary

Provides deep subject matter expertise for enterprise Molina risk and quality solutions (RQS) activities. Collaborates with health plan risk and quality leaders to support implementation of best quality/risk practices for optimal performance. Ensures that all RQS action plans are complete, accurate and reflect objectives necessary to achieve established risk/quality performance goals.

Essential Job Duties

• Provides risk and quality support to a selection of state health plans; leverages established risk and quality solutions (RQS) best practices to support health plan achievement of risk/quality goals, with oversight senior quality/risk adjustment leadership.
• Serves as a risk/quality industry subject matter expert to functional areas/health plans, and leads risk/quality-related programs to meet critical needs.
• Escalates gaps and barriers in risk/quality programs/initiatives implementation and compliance to leadership; partners with the execution team for resolution and barrier removal impeding health plan execution.
• Represents in a consultative role, supporting development of business case methodologies for incremental risk/quality programs; develops and coordinates implementation of business strategies.
• Collaborates and facilitates risk/quality-related activities with corporate/health plan teams.

Required Qualifications

• At least 8 years of managed care experience, including risk adjustment/quality-related experience supporting Medicaid, Medicare, and/or Marketplace, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Proficiency with risk adjustment methodologies.
• Quality/risk operational and process improvement experience.
• Proficiency with data analysis, manipulation and interpretation.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Ability to collaborate and drive/influence change and initiatives with internal/external stakeholders.
• Project management experience.
• Excellent verbal/written communication skills, and presentation skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Strong quality/risk adjustment project-related experience.
• Prior experience with Centers for Medicare and Medicaid Services (CMS) risk adjustment-related initiatives.
• Advanced knowledge and understanding of HEDIS and NCQA.
• Certified Professional in Healthcare Quality (CPHQ).

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $79,607.91 - $160,000 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.