Sr. Risk & Quality Performance Manager (Remote)

Lensa; City of Yonkers (NY); Remote; USD 77,000 - 172,000; Full time

Job summary

An established industry player is seeking a Sr. Risk & Quality Performance Manager to lead strategic initiatives within their Risk & Quality Solutions team. This pivotal role involves collaborating with various departments to enhance performance improvement initiatives and ensure alignment with strategic goals. The ideal candidate will have a strong background in program management, data analysis, and healthcare, with the ability to navigate complex organizational structures. Join this dynamic team and contribute to impactful projects that drive quality outcomes in healthcare.

Qualifications

• 4+ years in program/project management in risk adjustment and/or quality.
• Experience with data analysis using technical tools.
• Strong quantitative and communication skills.

Responsibilities

• Collaborate with Health Plan leaders to improve outcomes through data analytics.
• Manage risk/quality data and optimize data impact.
• Ensure program deliverables meet quality standards.

Skills

Program/Project Management

Data Analysis

Risk Adjustment Knowledge

Communication Skills

Problem-Solving Skills

Healthcare Experience

Collaboration Skills

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Azure

SQL Server

Microsoft Office Suite

Job description

Sr. Risk & Quality Performance Manager (Remote)

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Job Description

Job Summary

The Sr Risk & Quality Performance Manager is a strategic role responsible for leading projects supporting Molina’s Risk & Quality Solutions (RQS) team and program outcomes. This position collaborates with various departments and stakeholders to plan, coordinate, and execute performance improvement initiatives aligned with RQS’s strategic goals.

Job Duties

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing data collection strategies, analytics, and reporting, including risk/quality rate trending, provider performance, CAHPS and survey analytics, health equity, SDOH, and engaging external vendors.
• Ensure timely, scoped, and resource-efficient delivery of programs.
• Manage risk/quality data ingestion and optimize EHR/HIE and supplemental data impact.
• Meet customer expectations, build effective relationships, and gain trust and respect.
• Resolve complex problems through project management, data analytics, and stakeholder collaboration.
• Manage program changes and ensure alignment with goals.
• Handle complex assignments and keep leadership informed of progress.
• Draw actionable insights, make decisions, and collaborate with teams.
• 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 implement mitigation strategies.
• Proactively communicate risks and issues to stakeholders and leadership.
• Create, review, and maintain program documentation.
• Provide regular status updates highlighting progress, risks, and issues.
• Support other team requests as needed, functioning as a team SME.

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 data analysis using technical tools to address risk and quality 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 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

• Supporting leadership in cross-functional, matrixed organizations.
• 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 preferred.

To apply, current Molina employees should use the intranet job listing. Molina offers competitive benefits. EOE M/F/D/V.

Pay Range

$77,969 - $171,058 annually. Actual compensation varies based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Research, Analyst, IT
• Industries: IT Services and Consulting