Sr. Risk & Quality Performance Manager (Remote)

Lensa; Bellevue (NE); Remote; USD 77,000 - 172,000; Full time

Job summary

An established industry player is seeking a Senior Risk & Quality Performance Manager to lead projects that enhance risk and quality solutions. This remote position involves collaboration across departments to drive performance improvement initiatives aligned with strategic objectives. The ideal candidate will have a strong background in program management, data analysis, and stakeholder engagement within the healthcare sector. Join a dynamic team committed to improving healthcare outcomes through innovative solutions and data-driven strategies. If you are passionate about making a difference in the healthcare industry, this role offers an exciting opportunity to contribute to impactful projects.

Qualifications

• 4+ years in program/project management within risk adjustment or quality.
• Experience with HEDIS and risk adjustment reporting.

Responsibilities

• Collaborate with leaders to improve outcomes through data analytics.
• Manage program changes and ensure compliance with quality standards.

Skills

Program/Project Management

Data Analysis

SQL Server

Microsoft Excel

Stakeholder Management

Problem-Solving

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Azure

Microsoft Project

Job description

Senior Risk & Quality Performance Manager (Remote)

Molina Healthcare

Position Overview

The Sr. Risk & Quality Performance Manager is responsible for leading specific projects to support Molina’s Risk & Quality Solutions (RQS) team and program outcomes. This role involves collaboration across departments to plan, coordinate, and execute performance improvement initiatives aligned with strategic objectives.

Job Duties

1. Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing data collection strategies, analytics, and reporting, including risk/quality trend analysis, provider performance, CAHPS, health equity, and SDOH.
2. Ensure timely delivery of programs within scope and resources.
3. Manage data ingestion activities, optimizing EHR/HIE and supplemental data impact.
4. Build and maintain effective relationships with stakeholders, meeting their expectations.
5. Resolve complex problems through project management and data analytics.
6. Manage program changes, updates, and documentation to ensure quality standards and regulatory compliance.
7. Partner with teams to ensure data quality and identify opportunities to close care gaps.
8. Identify risks, develop mitigation strategies, and communicate proactively with stakeholders and leadership.
9. Provide regular status updates and ensure documentation is current and accessible.
10. Support other team requests and act as a subject matter expert.

Job Qualifications

Required Education: Bachelor’s degree or equivalent experience.

Required Experience/Skills:

• 4+ years in program/project management within risk adjustment or quality.
• Experience with HEDIS, risk adjustment reporting, and data analysis.
• Proficiency in SQL Server or Microsoft Azure queries.
• Strong skills in Microsoft Office, especially Excel and Project.
• Healthcare industry experience with risk adjustment and quality metrics.
• Excellent communication, problem-solving, and stakeholder management skills.

Preferred Education: Graduate degree or equivalent.

Preferred Experience:

• Supporting leadership in complex, matrixed organizations.
• Knowledge of healthcare claim elements (CPT, SNOMED, NDC, etc.).
• Experience impacting Risk Adjustment and HEDIS outcomes.

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

Molina Healthcare offers competitive benefits. Interested employees should apply through the intranet. We are an Equal Opportunity Employer. Pay range: $77,969 - $171,058 annually.