National Quality Performance Manager - HEDIS (Remote)

Molina Healthcare•Long Beach, CA

16h•Remote

About The Position

Provides subject matter expertise for Molina's quality performance solutions team. Collaborates with departments and stakeholders across the enterprise to plan, coordinate, and manage resources, and execute quality performance improvement initiatives in alignment with strategic objectives. The role manages quality data collection strategy, analytics, and reporting with health plan quality leaders. It oversees quality-related projects and data ingestion, analyzes performance data, supports regulatory audit readiness, and works with cross-functional teams to improve data quality and close quality care gaps. It also maintains program documentation and communicates status, risks, and issues to stakeholders.

Requirements

At least 3 years of program/project management experience in quality, or an equivalent combination of relevant education and experience.
Health care experience or demonstrated functional quality knowledge.
Intellectual agility and ability to simplify and clearly communicate complex concepts.
Proficiency with data analysis, manipulation, interpretation, and reporting.
Strong quantitative aptitude, critical-thinking, problem-solving, and analytical skills.
Attention to detail and organizational skills.
Ability to work collaboratively in a highly matrixed organization.
Effective verbal, written, and presentation communication skills.
Proficiency with Microsoft Office, including Excel, and applicable software programs, with the ability to learn and navigate new software programs.

Nice To Haves

Familiarity with running queries in Microsoft Azure or SQL Server.
Intermediate knowledge or experience related to NCQA, HEDIS, CMS, and state-specific regulatory submission requirements.
Knowledge of health care claim elements and codes, including CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, and TINs.
Experience in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
Project Management Professional (PMP) certification.
Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

Responsibilities

Collaborate with health plan quality leaders to improve outcomes by managing quality data collection strategy, analytics, and reporting, including quality rate trending and forecasting, provider quality measurement performance, CAHPS and survey analytics, health equity and SDOH, and external vendor engagement.
Monitor quality-related projects from inception through successful delivery.
Oversee quality data ingestion activities, including data validation, issue identification, and documentation, to improve completeness and accuracy of EHR/HIE and supplemental data impact.
Analyze quality data and identify potential performance improvement opportunities.
Ensure compliance with quality-related regulatory audit guidelines by following deliverable roadmaps and timelines, and implement solutions to maximize national HEDIS audit success.
Partner with cross-functional teams to ensure data quality delivery through sequential transformations and identify opportunities to close quality care gaps.
Create, review, and update quality-related program documentation, including plans, reports, and records, and ensure information is accessible to enterprise quality teams.
Communicate regular quality-related status reports to stakeholders, highlighting progress, risks, and issues.
Meet customer expectations and requirements, establish and maintain effective relationships, and gain trust and respect.