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Risk & Quality Performance Manager (Remote)
Molina Healthcare Augusta, Georgia; Bellevue, Nebraska; Cedar Rapids, Iowa; Lincoln, Nebraska; Provo, Utah; Tacoma, Washington; Georgia; Utah; Buffalo, New York; Louisville, Kentucky; Covington, Kentucky; Dayton, Ohio; Orlando, Florida; Dallas, Texas; Ohio; Cincinnati, Ohio; Owensboro, Kentucky; Boise, Idaho; Bellevue, Washington; Nampa, Idaho; Grand Island, Nebraska; Davenport, Iowa; Bowling Green, Kentucky; San Antonio, Texas; Iowa; Fort Worth, Texas; Tampa, Florida; Houston, Texas; Omaha, Nebraska; Wisconsin; Texas; Everett, Washington; Meridian, Idaho; New York; Las Cruces, New Mexico; Mesa, Arizona; Columbus, Georgia; Racine, Wisconsin; Spokane, Washington; Phoenix, Arizona; Warren, Michigan; Washington; Idaho; Des Moines, Iowa; Atlanta, Georgia; Detroit, Michigan; Caldwell, Idaho; Roswell, New Mexico; Macon, Georgia; Idaho Falls, Idaho; Scottsdale, Arizona; Green Bay, Wisconsin; St. Petersburg, Florida; Kentucky; Orem, Utah; Cleveland, Ohio; Santa Fe, New Mexico; Albuquerque, New Mexico; Jacksonville, Florida; Lexington-Fayette, Kentucky; Nebraska; Madison, Wisconsin; Salt Lake City, Utah; West Valley City, Utah; Tucson, Arizona; Kearney, Nebraska; Austin, Texas; Iowa City, Iowa; Ann Arbor, Michigan; Florida; Michigan; New Mexico; Layton, Utah; Sterling Heights, Michigan; Columbus, Ohio; Chandler, Arizona; Rochester, New York; Miami, Florida; Savannah, Georgia; Sioux City, Iowa; Yonkers, New York; Akron, Ohio; Milwaukee, Wisconsin; Vancouver, Washington; Syracuse, New York; Albany, New York; Grand Rapids, Michigan; Rio Rancho, New Mexico; Kenosha, Wisconsin Job ID 2032827
Job Summary
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
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $120,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type Full Time Posting Date 07/29/2025Job Alerts
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