Sr. Risk & Quality Performance Manager (Remote)

$73,102 - $171,058/Yr

Molina Healthcare - Spokane, WA

Full-time

Remote - Spokane, WA

Insurance Carriers and Related Activities

About the position

The Sr Risk & Quality Performance Manager is responsible for leading projects that support Molina's Risk & Quality Solutions team. This role involves collaboration with various departments to manage resources and execute performance improvement initiatives aligned with strategic objectives. The position requires a strong focus on data analysis, project management, and stakeholder engagement to enhance risk and quality outcomes.

Responsibilities

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategy, analytics, and reporting.
• 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.

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.

Benefits

• Competitive benefits and compensation package.