Sr. Risk & Quality Performance Manager (Remote)

Lensa; Racine (WI); Remote; USD 77,000 - 172,000; Full time

Job summary

An established industry player is seeking a Sr. Risk & Quality Performance Manager to lead critical projects within their Risk & Quality Solutions team. In this remote role, you will collaborate with various departments to enhance healthcare outcomes through effective data management and analytics. Your expertise in program management and healthcare quality will drive performance improvement initiatives aligned with strategic objectives. This is an exciting opportunity to make a significant impact in a dynamic environment where your skills in data analysis and leadership will be highly valued.

Qualifications

• 4+ years in program/project management with a focus on risk adjustment.
• Strong data analysis skills and experience with SQL and Azure.

Responsibilities

• Manage data collection strategies and improve quality outcomes.
• Resolve complex problems through analytics and stakeholder collaboration.

Skills

Program/Project Management

Data Analysis

Microsoft Azure

SQL Server

Microsoft Office

Healthcare Knowledge

Quantitative Skills

Communication Skills

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Excel

Microsoft Project

Job description

Sr. 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 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 performance, CAHPS and survey analytics, health equity, SDOH, and vendor engagement.
2. Ensure programs are delivered on time, within scope, and within resource constraints.
3. Manage Risk/Quality data ingestion activities and strategies, including EHR/HIE and supplemental data impact optimization.
4. Meet customer expectations, establish, and maintain effective relationships, and earn 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 collaborate with teams for decision-making.
9. Ensure program deliverables meet quality standards and regulatory requirements.
10. Partner with teams to ensure data quality and identify opportunities to close care gaps.
11. Identify risks and implement mitigation strategies.
12. Communicate risks and issues proactively to stakeholders and leadership.
13. Create, review, and approve program documentation, ensuring it is current and accessible.
14. Provide regular status updates to stakeholders, highlighting progress, risks, and issues.
15. Function as a team SME and support other requests as needed.

Job Qualifications

Required Education

Bachelor’s degree or equivalent experience.

Required Skills & Experience

• 4+ years in program/project management in risk adjustment or quality.
• 4+ years supporting HEDIS engine activity, risk adjustment targeting, and reporting systems.
• Data analysis experience with technical skills to answer complex questions.
• Experience with queries in Microsoft Azure or SQL Server.
• Proficiency in Microsoft Office, especially Excel and Project.
• Healthcare experience with strong risk adjustment and quality knowledge.
• Experience partnering with leadership across complex organizations.
• Strong quantitative and problem-solving skills.
• Ability to 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 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.

Additional Information

Apply through the intranet if you are a current Molina employee. Molina offers competitive benefits. Equal Opportunity Employer. Pay range: $77,969 - $171,058 annually, varies by location and experience.