Senior Risk & Quality Performance Manager (Remote)

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

Job summary

Lensa is seeking a Senior Risk & Quality Performance Manager to lead projects within Molina Healthcare's Risk & Quality Solutions team. This remote role focuses on improving healthcare outcomes through effective data management and collaboration with various departments. Candidates should have a strong background in program management, data analysis, and healthcare quality, with a Bachelor's degree and relevant experience.

Benefits

Competitive benefits

Qualifications

• 4+ years in program/project management in risk adjustment and/or quality.
• Experience with HEDIS engine activity and risk adjustment targeting.
• Strong healthcare knowledge with risk adjustment and quality.

Responsibilities

• Lead projects to improve risk/quality outcomes and manage data collection.
• Collaborate with stakeholders to ensure program deliverables meet standards.
• Identify risks and execute mitigation strategies.

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)

Be among the first 25 applicants. 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 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

• 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, provider measure performance, CAHPS and survey analytics, health equity, SDOH, and engaging external vendors.
• Ensure programs are delivered on time, within scope, and within resource constraints.
• Manage Risk/Quality data ingestion activities and strategies, including optimization of EHR/HIE and supplemental data impact.
• Meet customer expectations, establish, and maintain effective relationships, and gain trust and respect.
• Resolve complex problems through project management, data analytics, and stakeholder collaboration.
• Manage program changes and ensure alignment with goals.
• Handle complex assignments and update leadership as projects develop.
• Draw actionable conclusions and make decisions collaboratively.
• Ensure program deliverables meet quality standards and regulatory requirements.
• Partner with other teams to ensure data quality and identify opportunities to close care gaps.
• Identify potential risks and execute mitigation strategies.
• Proactively communicate risks and issues to stakeholders and leadership.
• Create, review, and approve program documentation, including plans, reports, and records, ensuring they are updated and accessible.
• Proactively communicate regular status reports to stakeholders, highlighting progress, risks, and issues.
• 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 in risk adjustment and/or quality.
• 4+ years supporting HEDIS engine activity, risk adjustment targeting, and reporting systems.
• Data analysis experience using technical skills to address risk and quality questions.
• Experience with queries in Microsoft Azure or SQL Server.
• Proficiency in Microsoft Office Suite, especially Excel and Project.
• Healthcare experience with strong risk adjustment and/or quality knowledge.
• Experience partnering with leadership across complex organizations.
• Strong quantitative skills and problem-solving abilities.
• Ability to simplify complex concepts and communicate effectively.
• Excellent verbal, written, and presentation skills.
• Energetic and collaborative attitude.

Preferred Education:

Graduate degree or equivalent experience.

Preferred Experience:

• Experience supporting leadership in a matrixed organization.
• SQL fluency.
• Knowledge of healthcare claim elements (CPT, LOINC, SNOMED, etc.).
• Success in roles impacting Risk Adjustment and HEDIS.

Preferred Certifications:

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

To apply, current Molina employees should use the intranet. Molina offers competitive benefits. Equal Opportunity Employer. Pay Range: $77,969 - $171,058 annually.