Sr. Risk & Quality Performance Manager (Remote)

$73,102 - $171,058/Yr

Molina Healthcare - Green Bay, WI

Full-time

Remote - Green Bay, WI

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 strong project management skills, data analysis capabilities, and the ability to communicate effectively with stakeholders.

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, establishing and maintaining effective relationships.
• Resolve complex problems through project management, data analytics, and stakeholder collaboration.
• Manage program changes and ensure alignment with program goals.
• Draw actionable conclusions and make decisions while collaborating with other teams.
• Ensure that program deliverables meet all quality standards and regulatory requirements.
• Partner with other teams to ensure data quality 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.
• 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.
• 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.
• Strong quantitative aptitude and problem solving skills.
• Excellent verbal, written and presentation capabilities.

Nice-to-haves

• Graduate degree or equivalent combination of education and experience.
• Experience supporting leadership 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.

Benefits

• Competitive benefits and compensation package.