Senior National Quality Performance Manager (Remote)

Molina Healthcare; Northern (KY); Hybrid; USD 66,000 - 136,000; Full time

Job summary

Molina Healthcare in Kentucky seeks a senior-level consultant to support the quality performance solutions team. You will collaborate with health plan quality leaders across the enterprise to plan, coordinate, and manage resources for quality improvement initiatives aligned with strategic objectives.

Responsibilities include leading data collection strategy, analytics, CAHPS, health equity, and external vendor engagement; ensuring timely delivery within scope and resources; guiding data

Qualifications

• 4+ years in program/project management in quality, with HEDIS experience or equivalent.
• Healthcare experience and knowledge of quality concepts.
• Familiarity with SQL-based data queries and reporting.
• Strong analytical and communication skills; detail oriented.

Responsibilities

• Lead quality data collection strategy, analytics, and reporting for quality metrics.
• Improve outcomes by CAHPS and survey analytics, health equity, and SDOH.
• Ensure on-time delivery of quality programs within scope and resources.
• Oversee data ingestion and accuracy for EHR/HIE data.
• Identify and resolve complex quality issues using data analysis and PM skills.
• Communicate risks, progress, and decisions to leadership and stakeholders.

Skills

Program management

Quality metrics

Data analysis

SQL

Communication skills

Excel

Cross-functional collaboration

Tools

Azure SQL

Azure Databricks

SQL Server

Job description

Provides senior level consultant level support for Molina’s quality performance solutions team. Collaborates with various departments and stakeholders across the enterprise to plan, coordinate, and manage resources, and execute quality performance improvement initiatives in alignment with strategic objectives.

Essential Job Duties

• Collaborates with health plan quality leaders to improve outcomes by leading quality data collection strategy, analytics, and reporting for the following: quality rate trending and forecasting, provider quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement.
• Ensures quality programs are successfully delivered on time, within scope, and within resource constraints.
• Oversees quality data ingestion activities and strategies to optimize completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact.
• Independently identifies, analyzes, and resolves complex quality issues using data analysis, project management skills, and cross-functional collaboration.
• Leads execution of complex quality assignments, supports program changes, ensures alignment with program goals, and updates leadership and applicable parties on program/project development.
• Draws actionable quality-related conclusions and recommends performance improvement initiatives.
• Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines, and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success.
• Partners with cross-functional teams to ensure data quality delivery through sequential transformations, draws actionable conclusions, and identifies opportunities to close quality care gaps.
• Ensures that program deliverables meet all quality standards and regulatory requirements.
• Creates and reviews quality-related program documentation, including plans, reports, and records, ensuring deliverables meet quality standards and regulatory requirements.
• Proactively communicates risks, issues, and progress to stakeholders and escalates unresolved or high-impact concerns to leadership as appropriate.
• Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.
• Provides advanced subject matter support within the quality team; maintains flexibility to pivot and support other requests as needed.
• Provides informal guidance and knowledge sharing to team members related to assigned quality initiatives and processes.

Required Qualifications

• At least 4 years of program/project management experience in quality, including experience supporting HEDIS activities targeting and reporting, or equivalent combination of relevant education and experience.
• Health care experience and functional quality knowledge.
• Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server.
• Intellectual agility and ability to simplify and clearly communicate complex concepts.
• Proficiency with data analysis, manipulation, interpretation, and reporting.
• Strong quantitative aptitude, critical-thinking, problem-solving, and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Effective verbal, written and presentation communication skills.
• Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs.

Preferred Qualifications

• Intermediate knowledge/experience related to National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS), and state-specific regulatory submission requirements.
• Microsoft Azure Databricks and SQL proficiency.
• Knowledge of health care claim elements: Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine - Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), National Provider Identifiers (NPIs), Taxpayer Identification Numbers (TINs), etc.
• Experience working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
• Project Management Professional (PMP).
• Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $65,791.66 - $135,548.59 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.