Risk & Quality Performance Manager (Remote)

Lensa; City of Syracuse (NY); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization is seeking a Risk & Quality Performance Manager to support their Risk & Quality Solutions team. This role involves collaboration across departments to enhance performance initiatives and ensure compliance with regulatory standards. The ideal candidate will have experience in program management, data analysis, and healthcare quality improvement. Join a dynamic team committed to making a difference in healthcare outcomes.

Qualifications

• 2+ years of program/project management experience in risk adjustment and/or quality.
• 2+ years supporting HEDIS activities.
• Familiarity with queries in Microsoft Azure or SQL Server.

Responsibilities

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

Skills

Data Analysis

Problem-Solving

Communication

Collaboration

Quantitative Skills

Education

Bachelor’s Degree

Graduate Degree

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Job description

Risk & Quality Performance Manager (Remote)

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

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

1. 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, survey analytics, health equity, SDOH, and engaging external vendors.
2. Monitor projects from inception through delivery.
3. Oversee data ingestion activities to ensure completeness and accuracy of EHR/HIE and supplemental data.
4. Meet customer expectations, establish effective relationships, and build trust.
5. Draw actionable conclusions and collaborate with teams for decision-making.
6. Ensure compliance with regulatory audits, adhering to deliverables and timelines to maximize HEDIS audit success.
7. Partner with teams to ensure data quality and identify opportunities to close care gaps.
8. Communicate risks and issues proactively to stakeholders and leadership.
9. Create, review, and approve program documentation, ensuring accessibility and updates.
10. 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 experience in risk adjustment and/or quality.
• 2+ years supporting HEDIS activities, risk adjustment targeting, and reporting systems.
• 2+ years data analysis experience using technical skills to address nuanced 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 partner with leadership across complex organizations.
• Strong quantitative, problem-solving, and communication skills.
• Energetic, collaborative, and adaptable.

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 like CPT, LOINC, SNOMED, HCPCS, NDC, CVX, NPIs, TINs.

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

Current Molina employees should apply via the intranet. Molina offers competitive benefits. We are an Equal Opportunity Employer.