Risk & Quality Performance Manager (Remote)

Molina Healthcare; Vancouver (WA); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare organization is seeking a Risk & Quality Performance Manager to join its Risk & Quality Solutions team. This vital role involves collaboration across departments to enhance performance initiatives and manage compliance for regulatory audits. The ideal candidate is an experienced professional with a strong background in risk adjustment, data analysis, and effective stakeholder management. Candidates with a PMP or Six Sigma certification are preferred as the organization seeks individuals who can drive performance improvements in diverse healthcare settings.

Qualifications

• 2+ years of program/project management in risk adjustment/quality.
• Experience supporting HEDIS engine activity in healthcare.
• Strong knowledge of NCQA, CMS, and state regulatory requirements.

Responsibilities

• Manage data collection strategy for Risk/Quality initiatives.
• Ensure compliance with regulatory guidelines for audits.
• Collaborate with internal and external stakeholders to improve outcomes.

Skills

Data analysis

Project management

Collaboration

Quantitative aptitude

Problem solving

Verbal communication

Written communication

Presentation skills

Education

Bachelor's degree

Graduate degree

Tools

Microsoft Azure

SQL server

Microsoft Office Suite

Job description

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.

Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.