Risk & Quality Performance Manager (Remote)

Lensa; Milwaukee (WI); 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 with various departments to manage performance improvement initiatives. The ideal candidate will have a strong background in project management, data analysis, and healthcare quality. Responsibilities include overseeing data strategies, ensuring compliance with regulations, and communicating effectively with stakeholders. Competitive salary and benefits offered.

Qualifications

• 2+ years in program/project management in risk adjustment and/or quality.
• Experience supporting HEDIS engine activities and data analysis.

Responsibilities

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

Skills

Project Management

Data Analysis

Communication

Problem Solving

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 supports Molina’s Risk & Quality Solutions (RQS) team. This role collaborates with various departments and stakeholders within Molina to plan, coordinate, and manage resources, executing performance improvement initiatives aligned with RQS’s strategic objectives.

Job Duties

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategies, analytics, and reporting, including risk/quality rate trending, provider performance, CAHPS and survey analytics, health equity, SDOH, and engaging external vendors.
• Monitor projects from inception to successful delivery.
• Oversee Risk/Quality data ingestion activities to ensure completeness and accuracy of EHR/HIE and supplemental data.
• Meet customer expectations and requirements, establishing effective relationships and gaining trust.
• Draw actionable conclusions and collaborate with teams for decision-making.
• Ensure compliance with regulatory audit guidelines, adhering to deliverables and timelines, and maximize HEDIS audit success.
• 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.
• Ensure documentation accessibility and provide regular status updates to stakeholders.

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.
• 2+ years supporting HEDIS engine activities, risk adjustment targeting, and reporting systems.
• 2+ years data analysis experience using technical skills to address nuanced questions.
• Familiarity with queries in Microsoft Azure or SQL Server.
• Healthcare experience with risk adjustment and/or quality knowledge.
• Proficiency in Microsoft Office Suite, including Excel and Project.
• Experience working with leadership across 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 coursework.

To apply, current Molina employees should use the intranet. Molina offers competitive benefits and is an EOE M/F/D/V.

Additional Details

• Salary Range: $77,969 - $155,508 annually.

Additional Info

• Entry level, full-time role.
• Functions include research, analysis, IT; industries include IT services and consulting.