Risk & Quality Performance Manager (Remote)

Lensa; Covington (KY); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company is seeking a Risk & Quality Performance Manager to support their Risk & Quality Solutions team. This remote role involves collaborating across departments to enhance performance through data analysis, compliance monitoring, and project management. Ideal candidates will have strong leadership and analytical skills, with a focus on healthcare quality improvement.

Qualifications

• 2+ years in program/project management in risk adjustment or quality.
• Experience supporting HEDIS activities and risk reporting systems.

Responsibilities

• Collaborate with Risk and Quality leaders to enhance outcomes through data collection and analytics.
• Monitor projects from start to finish and ensure compliance with regulatory guidelines.

Skills

Data analysis

Leadership

Problem-solving

Collaboration

Education

Bachelor’s degree

Graduate degree

Tools

SQL

Microsoft Office

Azure

Job description

Risk & Quality Performance Manager (Remote)

Be among the first 25 applicants. Get AI-powered advice on this job and more exclusive features.

Lensa, the leading career site, connects job seekers at every career stage. 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 across departments to plan, coordinate, and execute performance improvement initiatives aligned with RQS’s strategic goals.

Job Duties

• Collaborate with Risk and Quality leaders to enhance outcomes through data collection, analytics, and reporting, including trend analysis, provider performance, surveys, health equity, and vendor engagement.
• Monitor projects from start to finish.
• Oversee data ingestion activities to ensure accuracy and completeness.
• Build and maintain effective relationships, meeting customer expectations.
• Draw actionable insights and collaborate on decision-making.
• Ensure compliance with regulatory guidelines and maximize HEDIS audit success.
• Partner with teams to improve data quality and close care gaps.
• Communicate risks, issues, and project status proactively to stakeholders and leadership.
• Create and maintain program documentation, ensuring accessibility and updates.

Job Qualifications

Required Education: Bachelor’s degree or equivalent experience.

• 2+ years in program/project management in risk adjustment or quality.
• Experience supporting HEDIS activities and risk reporting systems.
• Data analysis skills with technical resources.
• Familiarity with SQL or Azure queries.
• Healthcare experience with risk adjustment and quality knowledge.
• Proficiency in Microsoft Office, especially Excel and Project.
• Leadership experience in complex organizations.
• Strong quantitative and problem-solving skills.
• Ability to simplify complex concepts and communicate effectively.
• Energetic, collaborative, and proactive.

Preferred Education: Graduate degree or equivalent experience.

• Knowledge of NCQA, CMS, and state regulations.
• Experience in a matrixed organization.
• SQL proficiency.
• Knowledge of healthcare claim elements (CPT, LOINC, SNOMED, etc.).

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

Current Molina employees should apply via the intranet. Molina offers competitive benefits. EOE M/F/D/V.

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

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Job functions: Research, Analysis, IT
• Industries: IT Services, Consulting