Senior Risk & Quality Performance Manager (Remote)

Lensa; Macon (GA); Remote; USD 77,000 - 172,000; Full time

Job summary

A leading company in healthcare is seeking a Senior Risk & Quality Performance Manager to lead projects for risk and quality improvement. This role involves collaboration across departments to enhance performance outcomes, manage data strategies, and ensure compliance with quality standards. The ideal candidate will have significant experience in program management, data analysis, and strong communication skills.

Benefits

Competitive benefits

Qualifications

• 4+ years in program/project management in risk adjustment and/or quality.
• 4+ years data analysis experience with technical skills.
• Experience running queries in Microsoft Azure or SQL Server.

Responsibilities

• Collaborate with leaders to improve outcomes through data collection strategy.
• Manage Risk/Quality data ingestion activities and strategies.
• Ensure program deliverables meet quality standards and regulatory requirements.

Skills

Data analysis

Project management

Communication

Problem-solving

Collaboration

Education

Bachelor’s degree or equivalent experience

Graduate degree or equivalent experience

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Job description

Senior Risk & Quality Performance Manager (Remote)

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 measure performance, CAHPS and survey analytics, health equity, SDOH, and engaging external vendors.
2. Ensure programs are delivered on time, within scope, and resource constraints.
3. Manage Risk/Quality data ingestion activities and strategies, including optimization of 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. Handle complex assignments and update leadership on project developments.
8. Draw actionable conclusions and make decisions collaboratively.
9. Ensure program deliverables meet quality standards and regulatory requirements.
10. Partner with teams to ensure data quality, identify opportunities to close care gaps, and improve risk and quality outcomes.
11. Identify potential risks and implement 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 accessibility and currency.
14. Proactively communicate regular status updates, highlighting progress, risks, and issues.
15. Function as a team SME, supporting 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.
• 4+ years data analysis experience with technical skills to answer complex risk and quality questions.
• Experience running queries in Microsoft Azure or SQL Server.
• Proficiency in Microsoft Office Suite, especially Excel and Project.
• Significant healthcare experience with strong risk adjustment and/or quality knowledge.
• Experience partnering with leadership across complex organizations.
• Strong quantitative, problem-solving, and communication skills.
• Energetic, collaborative, and adaptable.

Preferred Education: Graduate degree or equivalent experience.

Preferred Experience:

• Experience supporting leadership in a matrixed organization.
• SQL fluency.
• Extensive healthcare claim element knowledge.
• Success in roles impacting Risk Adjustment and HEDIS.

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

To apply, current Molina employees should use the intranet. Molina offers competitive benefits. EOE. Pay range: $77,969 - $171,058 annually.