Risk & Quality Performance Manager (Remote)

Molina Healthcare; Sterling Heights (MI); Remote; USD 70,000 - 110,000; Full time

Job summary

An established industry player is seeking a Risk & Quality Performance Manager to enhance healthcare outcomes through effective data management and collaboration. This role involves overseeing data collection strategies, ensuring compliance with audit guidelines, and driving performance improvement initiatives. The ideal candidate will possess a strong background in program management, data analysis, and healthcare, along with excellent communication skills. Join a forward-thinking team dedicated to making a positive impact in the healthcare sector, where your contributions will be valued and recognized.

Qualifications

• 2+ years of program/project management experience in risk adjustment and quality.
• Strong quantitative aptitude and problem-solving skills are essential.

Responsibilities

• Collaborate with Risk and Quality leaders to manage data collection and analytics.
• Ensure compliance with regulatory guidelines and maximize HEDIS audit success.

Skills

Program Management

Data Analysis

Healthcare Knowledge

Microsoft Azure

SQL Server

Microsoft Office Suite

Problem Solving

Presentation Skills

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Excel

Microsoft Project

Job description

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
• 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.

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Risk Manager Quality • Sterling Heights, MI, United States