Manager, Risk & Quality Systems (Remote)

$88,453 - $206,981/Yr

Molina Healthcare - Orem, UT

Full-time - Manager

Remote - Orem, UT

Insurance Carriers and Related Activities

About the position

The Manager of Risk & Quality Systems at Molina Healthcare is responsible for overseeing daily operations of the Risk & Quality Solutions (RQS) team, managing team performance, and driving the achievement of strategic goals. This role requires strong leadership, strategic thinking, and effective communication with team members and various stakeholders. The manager will handle a complex portfolio of data-improvement activities, ensuring alignment with RQS objectives and collaborating with different departments to enhance program performance.

Responsibilities

• Manage project and/or program managers within the Risk and Quality Systems team to align with RQS strategies and goals.
• Support annual quality data submissions including NCQA and state regulatory submissions.
• Design and develop data-focused strategies to improve data ingestion activities.
• Collaborate with Risk & Quality leaders to enhance program performance through meaningful reporting and analytics.
• Develop and maintain comprehensive project plans, ensuring timely and high-quality deliverables.
• Identify potential risks and develop mitigation strategies for project plans.
• Resolve complex problems through project management and stakeholder collaboration.
• Conduct regular reviews and audits to maintain performance standards.
• Address issues or discrepancies promptly to ensure program success.
• Develop data quality strategies to close risk and quality care gaps.
• Communicate effectively with stakeholders, reporting risks and issues with recommended solutions.
• Prepare and present regular status reports to stakeholders, highlighting progress and issues.
• Foster a collaborative and high-performing team environment.
• Promote professional development and knowledge sharing within the team.
• Mentor team members to develop their professional expertise.

Requirements

• Bachelor's degree or equivalent combination of education and experience.
• 8+ years of program and/or project management experience in risk adjustment and/or quality.
• 4-6 years of experience supporting HEDIS engine activity and risk adjustment targeting.
• 4-6 years of data analysis experience using technical skillsets to address risk and quality questions.
• People management experience demonstrating excellent leadership skills.
• Expertise in running queries in Microsoft Azure or SQL server.
• Mastery of Microsoft Office Suite including Excel and Project.
• Significant healthcare experience with excellent risk adjustment and quality knowledge.
• History of partnering with various levels of leadership in complex organizations.
• Comprehensive knowledge of managed healthcare drivers and the healthcare industry.
• Expert-level ability to think cross-functionally and identify cost/benefits for stakeholders.
• Strong quantitative aptitude and problem-solving skills.
• Ability to simplify and communicate complex concepts clearly.
• Excellent verbal, written, and presentation skills.
• Energetic and collaborative demeanor.
• Extensive knowledge of healthcare claim elements.

Nice-to-haves

• Graduate degree or equivalent combination of education and experience.
• Experience in a leadership role within a cross-functional, highly matrixed organization.
• SQL mastery.
• History of excelling in roles impacting both risk adjustment and quality.
• PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, or comparable coursework.

Benefits

• Competitive benefits and compensation package.