Risk & Quality Performance Manager

Risk & Quality Performance Manager

The Risk & Quality Performance Manager position will support Molina's Risk & Quality Solutions (RQS) team. 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.

Monitor projects from inception through successful delivery.

Oversee Risk / Quality data ingestion activities and strategies to optimize completeness and accuracy of EHR / HIE and supplemental data.

Meet customer expectations and requirements, establish, and maintain effective relationships and gain their trust and respect.

Draw actionable conclusions, and make decisions as needed while collaborating with other teams.

Ensure compliance with all regulatory audit guidelines by adhering to roadmap of deliverables 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 communicate 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 :

2+ years of program and / or project management experience in risk adjustment and / or quality

2+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems

2+ years of data analysis experience utilizing technical skillsets and resources to answer nuanced Risk and Quality questions posed from internal and external partners

Familiarity with running queries in Microsoft Azure or SQL server

Healthcare experience and functional risk adjustment and / or quality knowledge

Mastery of Microsoft Office Suite including Excel and Project

Experience 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 :

Knowledge of, and familiarity with, 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