Senior Risk & Quality Performance Manager (Remote)

Lensa; Green Bay (WI); Remote; USD 65,000 - 143,000; Full time

Job summary

A leading company is seeking a Senior Risk & Quality Performance Manager to lead projects supporting Risk & Quality Solutions. This remote role involves collaboration with various departments to enhance healthcare outcomes through effective data management and performance improvement initiatives.

Benefits

Competitive Benefits

Qualifications

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

Responsibilities

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes.
• Manage Risk/Quality data collection strategy and analytics.
• Ensure program deliverables meet quality standards and regulatory requirements.

Skills

Data Analysis

Problem Solving

Communication

Collaboration

Quantitative Skills

Education

Bachelor’s Degree

Graduate Degree

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Excel

Project

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

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, provider performance, CAHPS, survey analytics, health equity, SDOH, and external vendors.
2. Ensure programs are delivered on time, within scope, and resource constraints.
3. Manage Risk/Quality data ingestion activities and strategies, including EHR/HIE and supplemental data impact.
4. Meet customer expectations, establish effective relationships, and gain trust and respect.
5. Resolve complex problems through project management, data analytics, and stakeholder collaboration.
6. Manage program changes, ensuring alignment with goals.
7. Update leadership on project developments and manage complex assignments.
8. Draw actionable conclusions and collaborate with teams for decision-making.
9. Ensure program deliverables meet quality standards and regulatory requirements.
10. Partner with teams to ensure data quality and identify opportunities to close care gaps.
11. Identify risks and execute mitigation strategies.
12. Proactively communicate risks and issues to stakeholders and leadership.
13. Create, review, and approve documentation, including plans and reports, ensuring accessibility.
14. Provide regular status updates 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 in risk adjustment and/or quality.
• Experience supporting HEDIS engine activity, risk adjustment targeting, and reporting systems.
• Data analysis experience with technical skills to answer nuanced 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.
• Ability to partner across organizational levels.
• Strong quantitative, problem-solving, and communication skills.
• Energetic, collaborative, and adaptable.

Preferred Education

Graduate degree or equivalent experience.

Preferred 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.

Additional Details

To apply, use the intranet job listing. Molina offers competitive benefits. EOE. Pay range: $65,791.66 - $142,548.59 annually, varies by location, experience, education, and skills.