Risk & Quality Performance Manager (Remote)

Lensa; Atlanta (GA); Remote; USD 80,000 - 110,000; Full time

Job summary

A leading company is seeking a Risk & Quality Performance Manager to join their team. This remote position involves collaborating with various departments to enhance risk and quality solutions. The ideal candidate will have a Bachelor’s degree, at least 2 years of relevant experience, and strong analytical skills.

Qualifications

• At least 2 years of program or project management experience in risk adjustment and/or quality.
• Experience supporting HEDIS engine activities.
• Strong quantitative and problem-solving skills.

Responsibilities

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes.
• Monitor projects from inception to successful delivery.
• Ensure compliance with regulatory audit guidelines.

Skills

Data analysis

Problem-solving

Communication

Collaboration

Quantitative skills

Education

Bachelor’s degree or equivalent experience

Graduate degree or equivalent experience

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Job description

Risk & Quality Performance Manager (Remote)

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

The Risk & Quality Performance Manager position will support Molina’s Risk & Quality Solutions (RQS) team. This role involves collaborating with various departments and stakeholders within Molina to plan, coordinate, and manage resources, as well as executing performance improvement initiatives aligned with RQS’s strategic objectives.

Job Duties

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategies, analytics, and reporting, including risk/quality rate trending, forecasting, provider performance, CAHPS and survey analytics, health equity, SDOH, and engaging external vendors.
• Monitor projects from inception to successful delivery.
• Oversee Risk/Quality data ingestion activities to ensure completeness and accuracy of EHR/HIE and supplemental data.
• Meet customer expectations, establish effective relationships, and earn trust and respect.
• Draw actionable conclusions and collaborate with teams to make informed decisions.
• Ensure compliance with regulatory audit guidelines, adhere to deliverable timelines, and implement solutions to maximize HEDIS audit success.
• Partner with teams to ensure data quality through transformations and identify opportunities to close care gaps.
• Proactively communicate risks and issues to stakeholders and leadership.
• Create, review, and maintain program documentation, including plans, reports, and records.
• Update and ensure accessibility of documentation.
• Provide regular status reports to stakeholders, highlighting progress, risks, and issues.

Job Qualifications

Required Education

Bachelor’s degree or equivalent experience.

Required Skills & Experience

• At least 2 years of program or project management experience in risk adjustment and/or quality.
• Experience supporting HEDIS engine activities, risk adjustment targeting, and reporting systems.
• Data analysis experience using technical tools to answer complex Risk and Quality questions.
• Familiarity with queries in Microsoft Azure or SQL Server.
• Healthcare experience with risk adjustment and/or quality knowledge.
• Proficiency in Microsoft Office Suite, including Excel and Project.
• Ability to collaborate with leadership across complex organizations.
• Strong quantitative and problem-solving skills.
• Excellent communication skills, both verbal and written.
• Energetic and collaborative attitude.

Preferred Education

Graduate degree or equivalent experience.

Preferred Experience

• Knowledge of NCQA, CMS, and State regulatory requirements.
• Experience in a cross-functional, matrixed organization.
• SQL proficiency.
• Knowledge of healthcare claim elements like CPT, LOINC, SNOMED, HCPCS, NDC, CVX, NPIs, TINs, etc.

Preferred Certifications

PMP, Six Sigma Green Belt, Six Sigma Black Belt, or similar certifications preferred.

To apply, current Molina employees should use the intranet job listing. Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.