Senior Risk & Quality Performance Manager (Remote)

Lensa; Meridian (ID); Remote; USD 77,000 - 172,000; Full time

Job summary

A leading career site is seeking a Senior Risk & Quality Performance Manager to lead projects supporting Molina Healthcare's Risk & Quality Solutions. This role involves collaborating with various departments to enhance program 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.
• Extensive healthcare experience with strong risk adjustment and/or quality knowledge.
• Experience with data analysis using technical resources.

Responsibilities

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes.
• Manage Risk/Quality data ingestion activities and strategies.
• Ensure programs are delivered on time, within scope, and within resources.

Skills

Data analysis

Project management

Risk adjustment

Quality knowledge

Quantitative skills

Problem-solving

Communication

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)

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 supporting 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 aligned 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 performance, CAHPS, survey analytics, health equity, SDOH, and engaging external vendors.
• Ensure programs are delivered on time, within scope, and within resources.
• Manage Risk/Quality data ingestion activities and strategies, including EHR/HIE and supplemental data impact.
• Meet customer expectations, establish and maintain effective relationships, and build trust and respect.
• Resolve complex problems through project management, data analytics, and stakeholder collaboration.
• Manage program changes, ensuring 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 teams to ensure data quality and identify opportunities to close care gaps.
• Identify risks and execute mitigation strategies.
• Communicate risks and issues proactively to stakeholders and leadership.
• Create, review, and approve documentation, ensuring it is up-to-date and accessible.
• Provide regular status updates to stakeholders, highlighting progress and risks.
• 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 activities, risk adjustment targeting, and reporting systems.
• 4+ years of data analysis skills using technical resources.
• Experience with queries in Microsoft Azure or SQL Server.
• Proficiency in Microsoft Office Suite, including Excel and Project.
• Extensive healthcare experience with strong risk adjustment and/or quality knowledge.
• Experience partnering with leadership across complex organizations.
• Strong quantitative and problem-solving skills.
• Ability to simplify and 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 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.

Additional Information

Apply through the intranet if you are a current Molina employee. Molina offers competitive benefits. This position is full-time, mid-senior level, in the IT/Research field. Salary range: $77,969 - $171,058 annually, varies by location and experience.