Risk & Quality Performance Manager (Remote)

Lensa; Dallas (TX); Remote; USD 77,000 - 156,000; Full time

Job summary

An established industry player is seeking a Risk & Quality Performance Manager to enhance healthcare outcomes through strategic data management and collaboration. This full-time remote role involves overseeing performance improvement initiatives, ensuring compliance with regulatory standards, and fostering effective relationships across departments. Ideal candidates will bring a blend of analytical skills, healthcare knowledge, and a collaborative spirit to drive impactful change. Join a dynamic team dedicated to quality and innovation in healthcare, where your contributions will make a significant difference.

Qualifications

• 2+ years in risk adjustment or quality program management.
• Familiarity with HEDIS activities and data analysis.

Responsibilities

• Collaborate to improve outcomes through data collection and analytics.
• Monitor projects and ensure compliance with audit guidelines.

Skills

Risk Adjustment Management

Quality Program Management

Data Analysis

SQL Proficiency

Healthcare Knowledge

Problem-Solving Skills

Communication Skills

Leadership Experience

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Office

Azure

Job description

Risk & Quality Performance Manager (Remote)

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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 Risk and Quality leaders to improve outcomes through managing data collection, analytics, and reporting, including risk/quality rate trending, provider performance, CAHPS, 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, adhering to deliverables and timelines for HEDIS audits.
• 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 update program documentation and reports.
• Provide regular status updates to stakeholders, highlighting progress and risks.

Job Qualifications

Required Education: Bachelor’s degree or equivalent experience.
Experience/Skills: 2+ years in risk adjustment or quality program management, supporting HEDIS activities, data analysis, familiarity with SQL or Azure, healthcare knowledge, proficiency in Microsoft Office, leadership experience, strong problem-solving, and communication skills. Energetic and collaborative attitude.

Preferred Education & Experience

Graduate degree or equivalent; knowledge of NCQA, CMS, State regulations; SQL proficiency; healthcare claim elements knowledge; PMP or Six Sigma certifications are a plus.

Additional Information

This is a full-time remote role with a pay range of $77,969 - $155,508 annually, depending on experience and location. Molina offers competitive benefits and is an EOE.

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Research, Analysis, IT