Manager, Risk & Quality Systems (Remote)

$88,453 - $206,981/Yr

Molina Healthcare - Layton, UT

Full-time - Manager

Remote - Layton, 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 stakeholders across the organization.

Responsibilities

• Manages Risk and Quality Systems' project and/or program managers to ensure alignment with RQS strategies and goals.
• Supports the annual quality data submissions (NCQA and state regulatory submissions).
• Manages, designs, and develops data-focused strategies to improve data ingestion activities.
• Collaborates with Risk & Quality leaders to enhance program performance through meaningful reporting and analytics.
• Develops and maintains comprehensive project plans, schedules, and resource assignments.
• Identifies potential risks/barriers to project plans and develops mitigation strategies.
• Resolves complex problems through project management, data analytics, and stakeholder collaboration.
• Conducts regular reviews and audits to maintain high performance standards.
• Addresses issues or discrepancies promptly to ensure program success.
• Develops data quality strategies to close risk and quality care gaps.
• Communicates effectively with key stakeholders, reporting risks and issues with recommended solutions.
• Prepares and presents regular status reports to stakeholders, highlighting progress, risks, and issues.
• Fosters a collaborative and high-performing team environment.
• Promotes professional development and knowledge sharing within the team.
• Mentors team members to develop their professional Risk/Quality 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, risk adjustment targeting and reporting systems.
• 4-6 years of data analysis experience utilizing technical skillsets to answer nuanced risk and quality questions.
• People management experience demonstrating excellent leadership skills.
• Expertise 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.
• Comprehensive mastery of the drivers of value in managed health care and in-depth knowledge of the healthcare industry.
• Expert-level ability to think cross-functionally and identify cost/benefits to stakeholders.
• Strong quantitative aptitude and problem-solving skills.
• Intellectual agility and ability to simplify complex concepts.
• Excellent verbal, written, and presentation capabilities.
• Energetic and collaborative.
• Extensive knowledge of healthcare claim elements.

Nice-to-haves

• Graduate degree or equivalent combination of education and experience.
• Experience supporting leadership in 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, and/or comparable coursework.

Benefits

• Competitive benefits and compensation package.