Job Description
Job Description
Job Summary
The Lead Risk and Quality Performance Manager supports Molina’s Risk & Quality Solutions (RQS) team by overseeing large programs and multiple projects supporting Molina’s Risk Adjustment and Quality performance. 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.
• Provide oversight and direction for RA and Quality programs and projects.
• Develop detailed project plans, schedules, and assign resources.
• Ensure programs are successfully delivered on time, within scope, and within resource constraints.
• Manage Risk/Quality data ingestion activities and strategies to optimize completeness and accuracy of EHR/HIE and supplemental data.
• Lead activities and tasks across multiple teams and departments.
• Develop and implement best practices and continuous improvement initiatives.
• Manage program changes and ensure alignment with program goals.
• 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.
• Conduct regular reviews and audits to maintain high standards of performance.
• Address any issues or discrepancies promptly to ensure program success.
• Develop data quality strategies and solutions to close quality and risk care gaps.
• Identify potential risks and execute mitigation strategies.
• Conduct regular risk assessments and adjust plans, as necessary.
• Communicates risks and issues to stakeholders and recommend solutions.
• Maintain comprehensive program documentation, including plans, reports, and records.
• Prepare and present regular status reports to stakeholders, highlighting progress, risks, and issues.
• Ensure documentation is updated and accessible to relevant parties.
• Provide guidance and support to project managers and team members.
• Foster a collaborative and high-performing team environment.
• Promote professional development and knowledge sharing within the team.
Job Qualifications
REQUIRED EDUCATION:
Bachelor’s degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 6 years of program and/or project management experience in risk adjustment and/or quality
• 6 years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems
• 6 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.
• Comprehensive mastery of the drivers of value in managed health care as well as in-depth knowledge of the healthcare industry
• Expert-level ability to think cross-functionally, identifying cost/benefits to upstream and downstream stakeholders, and solutioning which sustains benefits to multiple groups and business areas
• 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
• Extensive knowledge and mastery of the nuances of healthcare claim elements: CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc.
PREFERRED EDUCATION:
Graduate degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
• Experience supporting leadership and operating in a leadership role while working in a cross-functional, highly matrixed organization
• SQL mastery
• History of excelling in roles impacting both risk adjustment and quality
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.
Job Info
Job Identification: 2029521
Job Category: Quality and Risk Adjustment
Posting Date: 2025-01-06T01:00:00 00:00
Job Schedule:
