Risk & Quality Performance Manager (Remote)

Lensa; Fort Worth (TX); 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. The role involves collaboration across departments to enhance performance improvement initiatives and ensure data quality. Candidates should have a bachelor's degree and relevant experience in program management, with a strong focus on data analysis and healthcare knowledge.

Benefits

Competitive benefits

Qualifications

• 2+ years in program/project management in risk adjustment and/or quality.
• Experience supporting HEDIS activities and reporting systems.
• Familiarity with healthcare claim elements like CPT, LOINC, SNOMED.

Responsibilities

• Collaborate with leaders to improve outcomes through data collection and analytics.
• Monitor projects from inception through successful delivery.
• Ensure compliance with regulatory audit guidelines.

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)

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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 position will support Molina’s Risk & Quality Solutions (RQS) team. This role involves collaborating with various departments within Molina to plan, coordinate, and manage resources, as well as 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 and survey analytics, health equity, SDOH, and engaging external vendors.
2. Monitor projects from inception through successful delivery.
3. Oversee data ingestion activities to ensure completeness and accuracy of EHR/HIE and supplemental data.
4. Meet customer expectations, establish and maintain effective relationships, and earn trust and respect.
5. Draw actionable conclusions and collaborate with other teams to make informed decisions.
6. Ensure compliance with regulatory audit guidelines, adhering to deliverables and timelines, and implement solutions to maximize HEDIS audit success.
7. Partner with teams to ensure data quality and identify opportunities to close care gaps.
8. Proactively communicate risks and issues to stakeholders and leadership.
9. Create, review, and maintain program documentation, ensuring accessibility and updates.
10. Provide regular status reports to stakeholders, 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 and/or quality.
• Experience supporting HEDIS activities, risk adjustment targeting, and reporting systems.
• Data analysis experience using technical tools 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 Suite, especially Excel and Project.
• Ability to collaborate across organizational levels.
• Strong quantitative, problem-solving, and communication 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 coursework.

Additional Information

To apply, current Molina employees should use 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, and skills.