Risk & Quality Performance Manager (Remote)

Lensa; City of Albany (NY); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company in healthcare is seeking a Risk & Quality Performance Manager to support their Risk & Quality Solutions team. This remote role involves managing performance improvement initiatives, collaborating with various departments, and ensuring compliance with regulatory standards. The ideal candidate will have a strong background in healthcare, data analysis, and project management, along with excellent communication skills.

Qualifications

• 2+ years of program/project management in risk adjustment or quality.
• Experience supporting HEDIS activities and risk adjustment reporting.
• Strong verbal, written, and presentation skills.

Responsibilities

• Collaborate with leaders to improve outcomes and manage data strategies.
• Monitor projects from inception to 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

Job description

Risk & Quality Performance Manager (Remote)

1 day ago Be among the first 25 applicants

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 supports Molina’s Risk & Quality Solutions (RQS) team. This role collaborates with various departments to plan, coordinate, and manage resources, executing performance improvement initiatives aligned with RQS’s strategic goals.

Job Duties

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing data collection strategies, analytics, and reporting, including risk/quality rate trending, provider performance, CAHPS and survey analytics, health equity, SDOH, and engaging external vendors.
• Monitor projects from inception to delivery.
• Oversee data ingestion activities to ensure completeness and accuracy of EHR/HIE and supplemental data.
• Meet customer expectations, establish effective relationships, and build trust.
• Draw actionable conclusions and collaborate with teams for decision-making.
• Ensure compliance with regulatory audit guidelines and maximize HEDIS audit success.
• Partner with teams to ensure data quality and identify opportunities to close care gaps.
• Proactively communicate risks and issues to stakeholders and leadership.
• Create, review, and maintain program documentation.
• Update and share documentation with relevant parties.
• Provide regular status reports highlighting progress, risks, and issues.

Job Qualifications

Required Education: Bachelor’s degree or equivalent experience

• 2+ years of program/project management in risk adjustment or quality
• 2+ years supporting HEDIS activities and risk adjustment reporting
• Data analysis experience with technical skills to answer nuanced questions
• Familiarity with queries in Microsoft Azure or SQL Server
• Healthcare experience with risk adjustment and/or quality knowledge
• Proficiency in Microsoft Office, especially Excel and Project
• Experience working with leadership in complex organizations
• Strong quantitative and problem-solving skills
• Ability to communicate complex concepts clearly
• Excellent verbal, written, and presentation skills
• Energetic and collaborative attitude

Preferred Education: Graduate degree or equivalent experience

• Knowledge of NCQA, CMS, and State regulatory requirements
• Experience in cross-functional, matrixed organizations
• SQL proficiency
• Knowledge of healthcare claim elements (CPT, LOINC, SNOMED, HCPCS, NDC, etc.)

Preferred Certifications: PMP, Six Sigma Green/Black Belt or similar coursework

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $155,508 annually. Actual compensation varies based on location, experience, education, and skills.