Senior Risk & Quality Performance Manager (Remote)

Molina Healthcare; Salt Lake City (UT); Remote; USD 75,000 - 95,000; Full time

Job summary

A leading healthcare company is seeking a Sr Risk & Quality Performance Manager who will lead critical projects to enhance risk and quality initiatives. The role involves collaboration across departments to ensure analytics and reporting meet the organization’s strategic objectives. Candidates should possess strong project management and data analysis experience, along with a solid knowledge of healthcare performance metrics. This challenging position offers opportunities to impact healthcare outcomes positively through effective risk management strategies.

Qualifications

• 4+ years of program and project management experience in risk adjustment and/or quality.
• Experience with HEDIS engine activity and risk adjustment targeting.
• Strong analytical and communication skills are essential.

Responsibilities

• Manage Risk/Quality data collection, analytics, and reporting.
• Ensure program deliverables meet quality and regulatory standards.
• Collaborate with stakeholders to resolve complex problems.

Skills

Project Management

Data Analysis

Risk Adjustment

Quality Assurance

Communication

Healthcare Knowledge

Education

Bachelor's degree or equivalent

Graduate degree or equivalent preferred

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Job description

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 but not limited to : Risk / Quality rate trending and forecasting; provider Risk / Quality measure performance, CAHPS and survey analytics, health equity and SDOH, and engaging external vendors.
• Ensure programs are successfully 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 and requirements, establish, and maintain effective relationships and gain their trust and respect.
• Resolve complex problems through project management, data analytics, and stakeholder collaboration.
• Manage program changes and ensure alignment with program goals.
• Manage complex assignments and update leadership as projects develop.
• Draw actionable conclusions, and make decisions as needed while collaborating with other teams.
• Ensure that program deliverables meet all quality standards and regulatory requirements.
• Partner with other teams to ensure data quality through sequential transformations and identify opportunities to close quality and risk 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.
• Ensure documentation is updated and accessible to relevant parties.
• Proactively communicate regular status reports to stakeholders, highlighting progress, risks, and issues.
• Ensure documentation is updated and accessible to relevant parties.
• Function as a team SME, while maintaining flexibility to pivot and support other requests as needed.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's degree or equivalent combination of education and experience

REQUIRED EXPERIENCE / KNOWLEDGE, SKILLS & ABILITIES :

• 4+ years of program and / or project management experience in risk adjustment and / or quality
• 4+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems
• 4+ years of data analysis experience utilizing technical skillsets and resources to answer nuanced risk and quality questions posed from internal and external partners
• Experience with running queries in Microsoft Azure or SQL server
• Mastery of Microsoft Office Suite including Excel and Project
• Significant healthcare experience and excellent risk adjustment and / or quality knowledge
• Accomplished history of partnering with various levels of leadership across complex organizations.
• Strong quantitative aptitude and problem solving skills
• Intellectual agility and ability to simplify and clearly communicate complex concepts
• Excellent verbal, written and presentation capabilities
• Energetic and collaborative

PREFERRED EDUCATION :

Graduate degree or equivalent combination of education and experience

PREFERRED EXPERIENCE :

• Experience supporting leadership while working in a cross-functional, highly matrixed organization
• SQL fluency
• Extensive knowledge of healthcare claim elements : CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc.
• History of success in roles impacting both Risk Adjustment and HEDIS

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and / or comparable coursework desired

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

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

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