Risk & Quality Performance Manager (Remote)

Lensa; Covington (KY); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare is seeking a Risk & Quality Performance Manager to enhance quality initiatives and manage risk data. This remote role involves collaboration across departments to drive performance improvements and ensure compliance with regulatory standards. Candidates should have a Bachelor's degree, relevant experience in program management, and strong analytical skills. Join a dynamic team dedicated to improving healthcare outcomes.

Qualifications

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

Responsibilities

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

Skills

Data Analysis

Problem Solving

Communication

Collaboration

Education

Bachelor’s Degree

Graduate Degree

Tools

Microsoft Azure

SQL Server

Microsoft Office

Excel

Project

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

Job Summary

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

Job Duties

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

Job Qualifications

Required Education: Bachelor’s degree or equivalent experience.

Required Experience/Skills:

• 2+ years in program/project management in risk adjustment or quality.
• 2+ years supporting HEDIS activities, risk adjustment targeting, and reporting systems.
• 2+ years of data analysis experience with technical skills to answer complex 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.

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, 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.