Senior Analyst, Risk & Quality Reporting (Remote)
Molina Healthcare Florida; Idaho; Iowa; Georgia; Kentucky; Michigan; Nebraska; New Mexico; Ohio; Texas; Utah; Washington; New York; Kenosha, Wisconsin; Racine, Wisconsin; Green Bay, Wisconsin; Madison, Wisconsin; Milwaukee, Wisconsin; Arizona Job ID 2031821Job Description
Job Summary
The Sr Analyst, Risk and Quality Reporting role supports Molina’s Risk and Quality Health Plan team. Designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of the initiatives. Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. Assists with research, development, and completion of special performance improvement projects including root cause analysis.
Job Duties
- Works with assigned health plan to capture and document requirements, build custom health plan reports, and educate health plan users on how to use reports
- Builds intervention strategy reporting for the Risk and Quality interventions and measures gap closure
- Builds ad hoc reports as requested to track HEDIS performance and supplemental data monitoring
- Develops and QA custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP
- Develops custom health plan reports related to managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates
- Assists and collaborates with the national Risk and Quality department with testing of pre-production reporting for the assigned health plan
- Calculates and tracks gap closure and intervention outcome reporting for the assigned state
- Works in an agile business environment to derive meaningful information out of complex and large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis
- Conducts root cause analysis for business data issues
- Analyzes data sets and trends for anomalies, outliers, trend changes, and opportunities, using databricks SQL, PowerBi, excel, and techniques to determine significance and relevance
- Assists with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations
- Key partner to assist with testing changes in the Datawarehouse platform and perform transparent upgrades to reporting modules to ensure no impact to the end users
- Conducts preliminary and post impact analyses for any logic and source code changes for data and reporting module keeping other variables as constant that are not of focus
- Develops oneself as a HEDIS subject matter expert to help health plan improve performance on underperforming measures
Job Qualifications
REQUIRED QUALIFICATIONS:
- Bachelor's Degree or equivalent combination of education and work experience
- 3-5 years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data
- 3-5 years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design
- 3-5 years of experience working with Microsoft T-SQL, Databricks SQL and PowerBI
- 1-3 years of experience with Microsoft Azure, AWS, or Hadoop
- 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment
- 3-5 years of experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics
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
#PJCorp
#LI-AC1
Pay Range: $77,969 - $141,371 / 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: 05/29/2025ABOUT OUR LOCATION
View Map- AVP, Market Share (Remote) Lexington-Fayette Kentucky, Bowling Green Kentucky, Owensboro Kentucky, Tucson Arizona, Rochester New York, Cleveland Ohio, Miami Florida, Scottsdale Arizona, Nebraska, Ohio, St. Petersburg Florida, Ann Arbor Michigan, Orem Utah, Spokane Washington, Boise Idaho, Sioux City Iowa, Nampa Idaho, Kenosha Wisconsin, Syracuse New York, Grand Island Nebraska, Idaho, Washington, Warren Michigan, San Antonio Texas, Austin Texas, Cincinnati Ohio, Louisville Kentucky, Madison Wisconsin, Buffalo New York, Utah, Racine Wisconsin, Jacksonville Florida, Albany New York, Covington Kentucky, Tampa Florida, Fort Worth Texas, Columbus Georgia, Roswell New Mexico, Tacoma Washington, Salt Lake City Utah, Atlanta Georgia, Macon Georgia, Georgia, Meridian Idaho, Everett Washington, Bellevue Nebraska, Columbus Ohio, Cedar Rapids Iowa, Santa Fe New Mexico, Las Cruces New Mexico, Orlando Florida, Yonkers New York, Michigan, Dallas Texas, Green Bay Wisconsin, Omaha Nebraska, Akron Ohio, Layton Utah, Phoenix Arizona, Savannah Georgia, Lincoln Nebraska, Rio Rancho New Mexico, Albuquerque New Mexico, Idaho Falls Idaho, Milwaukee Wisconsin, New Mexico, Wisconsin, Sterling Heights Michigan, Chandler Arizona, Bellevue Washington, Augusta Georgia, Grand Rapids Michigan, Detroit Michigan, Provo Utah, Vancouver Washington, New York, Florida, Mesa Arizona, Davenport Iowa, Iowa City Iowa, Dayton Ohio, Caldwell Idaho, West Valley City Utah, Des Moines Iowa, Kearney Nebraska, Houston Texas, Texas, Kentucky, Iowa 06/19/2025
- Care Review Clinician, Prior Authorization Nurse: California San Jose California, San Francisco California, Sacramento California, San Diego California, Los Angeles California 06/19/2025
- Director, Appeals & Grievances - REMOTE Florida, Everett Washington, Bellevue Washington, Owensboro Kentucky, West Valley City Utah, Cleveland Ohio, Idaho, Kearney Nebraska, Cincinnati Ohio, Columbus Georgia, Tucson Arizona, Sioux City Iowa, Nampa Idaho, Ann Arbor Michigan, Racine Wisconsin, Syracuse New York, Atlanta Georgia, Yonkers New York, Provo Utah, Washington, Des Moines Iowa, Columbus Ohio, Boise Idaho, Lincoln Nebraska, Tacoma Washington, Orem Utah, Santa Fe New Mexico, Grand Rapids Michigan, Buffalo New York, Cedar Rapids Iowa, Idaho Falls Idaho, Chandler Arizona, Milwaukee Wisconsin, Scottsdale Arizona, Fort Worth Texas, Albany New York, Savannah Georgia, St. Petersburg Florida, Dayton Ohio, San Antonio Texas, Madison Wisconsin, Salt Lake City Utah, Kentucky, Texas, Louisville Kentucky, Bellevue Nebraska, Akron Ohio, Jacksonville Florida, Albuquerque New Mexico, Las Cruces New Mexico, Lexington-Fayette Kentucky, Warren Michigan, Georgia, Ohio, New York, Michigan, Utah, Layton Utah, Augusta Georgia, Dallas Texas, Orlando Florida, Detroit Michigan, Tampa Florida, Kenosha Wisconsin, Wisconsin, New Mexico, Roswell New Mexico, Rio Rancho New Mexico, Spokane Washington, Caldwell Idaho, Covington Kentucky, Omaha Nebraska, Davenport Iowa, Iowa City Iowa, Phoenix Arizona, Rochester New York, Sterling Heights Michigan, Meridian Idaho, Grand Island Nebraska, Macon Georgia, Houston Texas, Iowa, Austin Texas, Green Bay Wisconsin, Bowling Green Kentucky, Miami Florida, Mesa Arizona, Vancouver Washington, Nebraska 06/18/2025
- Care Review Processor: NIGHT SHIFT California Long Beach California, San Francisco California, Sacramento California, Los Angeles California, San Jose California, San Diego California, California 06/19/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs