Risk & Quality Performance Manager (Remote)

Lensa; Macon (GA); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company in healthcare is seeking a Risk & Quality Performance Manager to support their Risk & Quality Solutions team. This remote position involves collaboration with various departments to enhance performance improvement initiatives and ensure compliance with regulatory standards. The ideal candidate will have a strong background in project management and data analysis, with a focus on healthcare quality metrics.

Qualifications

• 2+ years of program/project management experience in risk adjustment and/or quality.
• Experience supporting HEDIS engine activity and data analysis.
• Strong quantitative aptitude and problem-solving skills.

Responsibilities

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

Skills

Data analysis

Project management

Healthcare knowledge

Communication

Problem solving

Education

Bachelor’s degree

Graduate degree (preferred)

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Job description

Risk & Quality Performance Manager (Remote)

Risk & Quality Performance Manager (Remote)

1 day ago Be among the first 25 applicants

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 position collaborates with various departments and stakeholders within Molina to plan, coordinate, and manage resources and execute performance improvement initiatives in alignment with RQS’s strategic objectives.

Job Duties

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategy, analytics, and reporting, including but not limited to: Risk/Quality rate trending and forecasting; provider Risk/Quality measure performance, CAHPS and survey analytics, health equity and SDOH, and engaging external vendors.
• Monitor projects from inception through successful delivery.
• Oversee Risk/Quality data ingestion activities and strategies to optimize completeness and accuracy of EHR/HIE and supplemental data.
• Meet customer expectations and requirements, establish, and maintain effective relationships and gain their trust and respect.
• Draw actionable conclusions, and make decisions as needed while collaborating with other teams.
• Ensure compliance with all regulatory audit guidelines by adhering to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success.
• Partner with other teams to ensure data quality through sequential transformations and identify opportunities to close quality and risk care gaps.
• Proactively communicate risks and issues to stakeholders and leadership.
• Create, review, and approve program documentation, including plans, reports, and records.
• Ensure documentation is updated and accessible to relevant parties.
• Proactively communicate regular status reports to stakeholders, highlighting progress, risks, and issues.
  
  

Job Qualifications

REQUIRED EDUCATION:

Bachelor’s degree or equivalent combination of education and experience

Required Experience/Knowledge, Skills & Abilities

• 2+ years of program and/or project management experience in risk adjustment and/or quality
• 2+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems
• 2+ years of data analysis experience utilizing technical skillsets and resources to answer nuanced Risk and Quality questions posed from internal and external partners
• Familiarity with running queries in Microsoft Azure or SQL server
• Healthcare experience and functional risk adjustment and/or quality knowledge
• Mastery of Microsoft Office Suite including Excel and Project
• Experience partnering with various levels of leadership across complex organizations
• Strong quantitative aptitude and problem solving skills
• Intellectual agility and ability to simplify and clearly communicate complex concepts
• Excellent verbal, written and presentation capabilities
• Energetic and collaborative
  
  

Preferred Education

Graduate degree or equivalent combination of education and experience

Preferred Experience

• Knowledge of, and familiarity with, NCQA, CMS, and State regulatory submission requirements
• Experience working in a cross-functional, highly matrixed organization
• SQL proficiency
• Knowledge of healthcare claim elements: CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc.
  
  

Preferred License, Certification, Association

PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework desired

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJCorp

Pay Range: $77,969 - $155,508 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
  
  

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Research, Analyst, and Information Technology

• Industries

  IT Services and IT Consulting

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