Job Description
**Job Description**
**Job Summary**
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.
**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.
- 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.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Tags
Work experience placement, Work at office, Remote work,
Similar Jobs
University of Miami
...patients. He/ She will also provide inpatient and out-patient medical consultation in a variety of settings. Engagement in... ...Qualifications: MD Degree and ACGME US internal medicine internship and residency Completed 2 year ACGME US Rheumatology fellowship...
State of Florida
...Requisition No:850202 Agency: Highway Safety and Motor Vehicle Working Title: BUSINESS CONSULTANT I (WT: MS BUSINESS CONSULTANT I) - 76004850Pay Plan: Career Service Position Number:76004850 Salary: $36,067.20 Annually Posting Closing Date: 08/25/20...
Ksisters
...beauty and lifestyle brands under our belt. We aim to be the ultimate K-Beauty destination. We seek a dedicated & passionate Event Promoter , a character that is responsible, diligent and self-motivated. The Event Promoter will be responsible for maintaining high...
Kosmos
...Growing Manufacturing company 20 miles north of downtown Milwaukee has a need for a Quality Manager. This is a direct hire opening with a full benefits package. The Quality Assurance Manager is responsible for the overall quality system of the organization. Responsibilities...
Unilever
Internal Business Consultant**Department:** Inside Sales**Location:** Carson, CASTART YOUR APPLICATION (**Who We Are**Dermalogica stands tall as a beacon in the professional skincare realm, winning the trust of skin therapists across the globe. As a shining gem in...