Risk & Quality Performance Manager (Remote)

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

Job summary

An established industry player is seeking a Risk & Quality Performance Manager to join their dynamic team. This remote role involves collaborating with various departments to enhance performance initiatives, ensuring compliance with regulatory guidelines, and utilizing data analytics to drive improvements. You will play a key role in overseeing projects and building effective relationships to meet customer expectations. If you are passionate about healthcare quality and risk management, this is a fantastic opportunity to make a significant impact in a collaborative environment.

Qualifications

• 2+ years of program/project management in risk adjustment or quality.
• Experience with HEDIS activities and data analysis.
• Proficiency in Microsoft Office, especially Excel.

Responsibilities

• Collaborate with leaders to improve outcomes through data analysis.
• Monitor projects from inception to delivery.
• Ensure compliance with regulatory guidelines and maximize audit success.

Skills

Program/Project Management

Data Analysis

HEDIS Activities

SQL Proficiency

Microsoft Office (Excel, Project)

Quantitative Skills

Problem-Solving Skills

Communication Skills

Healthcare Knowledge

Collaboration Skills

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Azure

SQL Server

Job description

Risk & Quality Performance Manager (Remote)

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 will support Molina’s Risk & Quality Solutions (RQS) team. This role involves collaborating with various departments to plan, coordinate, and manage resources for performance improvement initiatives aligned with RQS’s strategic goals.

Job Duties

1. Collaborate with Risk and Quality leaders to improve outcomes through data collection, analytics, and reporting, including trend analysis, provider performance, CAHPS, survey analytics, health equity, and SDOH.
2. Monitor projects from inception to delivery.
3. Oversee data ingestion activities to ensure completeness and accuracy of EHR/HIE and supplemental data.
4. Meet customer expectations, establish effective relationships, and build trust.
5. Draw actionable insights and collaborate with teams for decision-making.
6. Ensure compliance with regulatory guidelines and maximize HEDIS audit success.
7. Partner with teams to ensure data quality and identify opportunities to close care gaps.
8. Proactively communicate risks, issues, and status updates to stakeholders and leadership.
9. Create, review, and maintain program documentation.
10. Ensure documentation is current and accessible.

Job Qualifications

Required Education

Bachelor’s degree or equivalent experience.

Required Skills & Experience

• At least 2 years of program/project management in risk adjustment or quality.
• Experience supporting HEDIS activities, risk adjustment, and reporting systems.
• Data analysis experience with technical skills for nuanced questions.
• Familiarity with queries in Microsoft Azure or SQL Server.
• Healthcare experience with risk adjustment and/or quality knowledge.
• Proficiency in Microsoft Office, especially Excel and Project.
• Ability to work with leadership across complex organizations.
• Strong quantitative, problem-solving, and communication skills.
• Energetic, collaborative, and adaptable.

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 (CPT, LOINC, SNOMED, etc.).

Preferred Certifications

PMP, Six Sigma Green/Black Belt or similar coursework preferred.

Additional Information

Interested current Molina employees should apply through the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Pay Range: $77,969 - $155,508 annually. Actual pay varies based on location, experience, education, and skills.