National Risk & Quality Performance Manager

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Collaborates with various departments and stakeholders across the enterprise to plan, coordinate, and manage resources, and execute quality and risk performance improvement initiatives in alignment with strategic objectives.</p>\n<p>&nbsp;</p>\n<p><span><strong>Essential Job Duties</strong></span></p>\n<p>• Collaborates with health plan risk and quality leaders to improve outcomes by managing risk and quality data collection strategy, analytics, and reporting for the following: &nbsp;risk/quality rate trending and forecasting, provider risk/quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement.&nbsp;<br>\n  • Monitors quality-related projects from inception through successful delivery.<br>\n  • Oversees risk/quality data ingestion activities and strategies to optimize completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact.<br>\n  • Proactively communicates quality/risk issues to stakeholders and leadership.<br>\n  • Draws actionable quality/risk-related conclusions and recommends performance improvement initiatives. &nbsp;<br>\n  • Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines, and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success.<br>\n  • Partners with cross-functional teams to ensure data quality delivery through sequential transformations, and identifies opportunities to close quality and risk care gaps.<br>\n  • Creates, reviews, and approves quality-related program documentation - including plans, reports, and records, and ensures information is accessible for quality teams throughout the enterprise.<br>\n  • Proactively communicates regular quality/risk-related status reports to stakeholders - highlighting progress, risks, and issues.<br>\n  • Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.<br>\n  &nbsp;</p>\n<p><span><strong>Required Qualifications</strong></span></p>\n<p><span>• At least 3 years of program/project management experience in risk adjustment and/or quality, including experience supporting HEDIS activities and risk adjustment targeting and reporting, or equivalent combination of relevant education and experience.</span><br><span>• Health care experience and functional risk adjustment/quality knowledge.</span><br><span>• Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server.</span><br><span>• Intellectual agility and ability to simplify and clearly communicate complex concepts.</span><br><span>• Proficiency with data analysis, manipulation, interpretation and reporting.</span><br><span>• Strong quantitative aptitude, critical-thinking, problem-solving and analytical skills.</span><br><span>• Attention to detail and organizational skills.</span><br><span>• Ability to work cross-collaboratively in a highly matrixed organization.</span><br><span>• Project management experience.</span><br><span>• Effective verbal, written and presentation communication skills.</span><br><span>• Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs.</span><br>\n  &nbsp;</p>\n<p><span><strong>Preferred Qualifications</strong></span></p>\n<p><span>• Intermediate knowledge/experience related to National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS), and state-specific regulatory submission requirements.</span><br><span>• Microsoft SQL proficiency.</span><br><span>• Knowledge of health care claim elements: &nbsp;Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine – Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), &nbsp;National Provider Identifiers (NPIs), Taxpayer Identification Numbers (TINs), etc.</span><br><span>• Experience working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.</span><br><span>• Project Management Professional (PMP).</span><br><span>• Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.</span><br>\n  &nbsp;</p>\n<p>&nbsp;</p>\n<p><span>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.</span><br><br><span>Molina Healthcare offers a competitive benefits and compensation package. 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