Risk & Quality Performance Manager

About the Role

The Risk & Quality Performance Manager will be an integral part of Molina's Risk & Quality Solutions (RQS) team. This role involves close collaboration with various departments and stakeholders to strategically plan, coordinate, and manage resources for performance improvement initiatives, ensuring alignment with RQS objectives.

Job Duties

• Collaborate with Health Plan Risk and Quality leaders to enhance outcomes through management of Risk/Quality data collection strategy, analytics, and reporting. This includes trending and forecasting risk/quality rates, provider performance on risk/quality measures, CAHPS and survey analytics, health equity, SDOH, and vendor engagement.
• Monitor projects from inception through successful delivery.
• Oversee Risk/Quality data ingestion activities and strategies to optimize the completeness and accuracy of EHR/HIE and supplemental data.
• Meet and exceed customer expectations, establishing and maintaining effective, trusted relationships.
• Draw actionable conclusions and make informed decisions in collaboration with other teams.
• Ensure compliance with all regulatory audit guidelines by adhering to deliverable roadmaps and timelines, and implementing solutions to maximize national HEDIS audit success.
• Partner with other teams to ensure data quality through sequential transformations and identify opportunities to close quality and risk care gaps.
• 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 deliver regular status reports to stakeholders, highlighting progress, risks, and issues.

Job Qualifications

Required Education:

• Bachelor's degree or equivalent combination of education and experience.

Required Experience/Knowledge, Skills & Abilities:

• Program/Project Management: 2+ years of experience in program and/or project management within risk adjustment and/or quality.
• HEDIS & Risk Adjustment: 2+ years of experience supporting HEDIS engine activity, risk adjustment targeting, and reporting systems.
• Data Analysis: 2+ years of data analysis experience utilizing technical skillsets to address complex Risk and Quality questions from partners.
• Data Systems: Familiarity with running queries in Microsoft Azure or SQL Server.
• Healthcare Knowledge: Healthcare experience and functional risk adjustment and/or quality knowledge.
• Software Proficiency: Mastery of Microsoft Office Suite, including Excel and Project.
• Leadership Collaboration: Experience partnering with various levels of leadership across complex organizations.
• Problem Solving: Strong quantitative aptitude and problem-solving skills.
• Communication: Intellectual agility to simplify and clearly communicate complex concepts; excellent verbal, written, and presentation capabilities.
• Collaboration: Energetic and collaborative approach.

Preferred Education:

• Graduate degree or equivalent combination of education and experience.

Preferred Experience:

• Knowledge of NCQA, CMS, and State regulatory submission requirements.
• Experience working in a cross-functional, highly matrixed organization.
• SQL proficiency.
• Knowledge of healthcare claim elements (CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc.).

Preferred License, Certification, Association:

• PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework desired.

Additional Information

• #PJCorp
• #LI-AC1
• Molina Healthcare offers a competitive benefits and compensation package.
• Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
• Current Molina employees should apply through the intranet job listing.