Sr Risk & Quality Performance Manager (Remote)

• 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.

Job Info

Job Identification: 2029522

Job Category: Quality and Risk Adjustment

Posting Date: 2025-01-06T01:01:25 00:00

Job Schedule: Full time