Senior Risk & Quality Performance Manager (Remote)

Molina Healthcare•Long Beach, CA

2h•Remote

About The Position

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.

Requirements

Bachelor’s degree or equivalent combination of education and experience
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

Nice To Haves

Graduate degree or equivalent combination of education and 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
PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework desired

Responsibilities

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.