Senior Risk & Quality Performance Manager (Remote)

Lensa; Dallas (TX); Remote; USD 77,000 - 172,000; Full time

Job summary

A leading healthcare organization is seeking a Senior Risk & Quality Performance Manager to lead initiatives that enhance risk and quality outcomes. This remote position requires collaboration across departments, data management, and project execution, aimed at improving healthcare delivery and compliance. Candidates should possess a strong background in program management, data analysis, and healthcare quality standards.

Qualifications

• 4+ years in program/project management related to risk adjustment and/or quality.
• Experience supporting HEDIS engine activities.
• Proficiency in data analysis tools and healthcare knowledge.

Responsibilities

• Lead projects to support Molina’s Risk & Quality Solutions team.
• Manage data collection strategies and analytics.
• Collaborate with stakeholders to improve outcomes.

Skills

Data analysis

Project management

Quantitative skills

Problem-solving

Communication

Education

Bachelor's degree

Graduate degree

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Job description

Senior Risk & Quality Performance Manager (Remote)

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Job Description

Job Summary

The Sr Risk & Quality Performance Manager is a tactical execution role that will lead specific projects to support Molina’s Risk & Quality Solutions (RQS) team and program outcomes. 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

1. Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategy, analytics, and reporting, including risk/quality rate trending, forecasting, provider performance, CAHPS, survey analytics, health equity, SDOH, and engaging external vendors.
2. Ensure programs are delivered on time, within scope, and within resource constraints.
3. Manage Risk/Quality data ingestion activities and strategies, including optimization of EHR/HIE and supplemental data impact.
4. Meet customer expectations and requirements, establish and maintain effective relationships, and earn trust and respect.
5. Resolve complex problems through project management, data analytics, and stakeholder collaboration.
6. Manage program changes and ensure alignment with program goals.
7. Handle complex assignments and update leadership as projects develop.
8. Draw actionable conclusions and make decisions collaboratively.
9. Ensure program deliverables meet quality standards and regulatory requirements.
10. Partner with other teams to ensure data quality, identify opportunities to close care gaps, and improve risk and quality outcomes.
11. Identify potential risks and execute mitigation strategies.
12. Proactively communicate risks and issues to stakeholders and leadership.
13. Create, review, and approve program documentation, including plans, reports, and records, ensuring they are updated and accessible.
14. Provide regular status reports to stakeholders, highlighting progress, risks, and issues.
15. Function as a team SME and support other requests as needed.

Job Qualifications

REQUIRED EDUCATION: Bachelor's degree or equivalent experience.

Required Experience/Skills:

• 4+ years in program/project management related to risk adjustment and/or quality.
• Experience supporting HEDIS engine activities, risk adjustment targeting, and reporting systems.
• Data analysis experience using technical tools to answer nuanced risk and quality questions.
• Experience with queries in Microsoft Azure or SQL Server.
• Proficiency in Microsoft Office Suite, including Excel and Project.
• Significant healthcare experience with strong risk adjustment and quality knowledge.
• Ability to partner effectively across organizational levels.
• Strong quantitative and problem-solving skills.
• Ability to communicate complex concepts clearly.
• Excellent verbal, written, and presentation skills.
• Energetic and collaborative attitude.

Preferred Education: Graduate degree or equivalent experience.

Preferred Experience:

• Experience supporting leadership in cross-functional, matrixed organizations.
• SQL fluency.
• Knowledge of healthcare claim elements (CPT, LOINC, SNOMED, HCPCS, NDC, etc.).
• Success in roles impacting Risk Adjustment and HEDIS.

Preferred Certifications: PMP, Six Sigma Green/Black Belt or similar coursework.

To all current Molina employees: Apply through the intranet.

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

Pay Range: $77,969 - $171,058 / ANNUAL