Risk & Quality Performance Manager (Remote)

Lensa; New York (NY); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare company is seeking a Risk & Quality Performance Manager to support their Risk & Quality Solutions team. This role involves collaborating with various departments to enhance performance through data analysis and project management. The ideal candidate will have a strong background in healthcare metrics, project management, and data analysis, ensuring compliance with regulatory guidelines. Competitive salary and benefits offered.

Qualifications

• At least 2 years in program/project management related to risk adjustment or quality.
• Experience supporting HEDIS activities and risk adjustment reporting systems.

Responsibilities

• Collaborate with Risk and Quality leaders to improve outcomes through data collection and analytics.
• Monitor projects from initiation to completion, ensuring timely delivery.
• Ensure compliance with regulatory guidelines and maximize success in HEDIS audits.

Skills

Data analysis

Communication

Problem-solving

Collaboration

Education

Bachelor’s degree

Graduate degree

Tools

Microsoft Azure

SQL

Microsoft Office

Excel

Project

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 execute performance improvement initiatives aligned with RQS’s strategic goals.

Key Responsibilities

• Collaborate with Risk and Quality leaders to improve outcomes through data collection, analytics, and reporting on risk/quality metrics, including trend analysis, provider performance, survey analytics, health equity, and SDOH, engaging external vendors as needed.
• Monitor projects from initiation to completion, ensuring timely delivery.
• Oversee data ingestion activities to ensure completeness and accuracy of EHR/HIE and supplemental data.
• Build and maintain effective relationships with stakeholders, ensuring expectations are met.
• Draw actionable insights from data and collaborate with teams to make informed decisions.
• Ensure compliance with regulatory guidelines and maximize success in HEDIS audits.
• Partner with teams to ensure data quality and identify opportunities to address care gaps.
• Proactively communicate risks, issues, and project status to stakeholders and leadership.
• Maintain and update program documentation, ensuring accessibility.

Qualifications

Required Education: Bachelor’s degree or equivalent experience.

Required Experience & Skills:

• At least 2 years in program/project management related to risk adjustment or quality.
• Experience supporting HEDIS activities and risk adjustment reporting systems.
• Data analysis skills with technical proficiency in querying in Microsoft Azure or SQL.
• Healthcare industry knowledge, including risk adjustment and quality metrics.
• Proficiency in Microsoft Office, especially Excel and Project.
• Strong communication, problem-solving, and collaboration skills.

Preferred Qualifications

Education: Graduate degree or equivalent.

Experience & Certifications:

• Knowledge of NCQA, CMS, and state regulations.
• Experience in cross-functional teams and SQL proficiency.
• Understanding of healthcare claim elements (CPT, LOINC, SNOMED, etc.).
• PMP or Six Sigma certifications preferred.

Additional Information
Salary Range: $77,969 - $155,508 annually.
Employment Type: Full-time, Entry level.
Job Function: Research, Analysis, IT.
Industries: IT Services and Consulting.
Molina Healthcare is an Equal Opportunity Employer.

Apply through the intranet if you are a current employee. We offer competitive benefits.