Risk & Quality Performance Manager (Remote)

Job Description Job Summary The Risk & Quality Performance Manager position will support Molinau2019s 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 RQSu2019s strategic objectives. Job Duties u2022 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. u2022 Monitor projects from inception through successful delivery. u2022 Oversee Risk/Quality data ingestion activities and strategies to optimize completeness and accuracy of EHR/HIE and supplemental data. u2022 Meet customer expectations and requirements, establish, and maintain effective relationships and gain their trust and respect. u2022 Draw actionable conclusions, and make decisions as needed while collaborating with other teams. u2022 Ensure compliance with all regulatory audit guidelines by adhering to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success. u2022 Partner with other teams to ensure data quality through sequential transformations and identify opportunities to close quality and risk care gaps. u2022 Proactively communicate risks and issues to stakeholders and leadership. u2022 Create, review, and approve program documentation, including plans, reports, and records. u2022 Ensure documentation is updated and accessible to relevant parties. u2022 Proactively communicate regular status reports to stakeholders, highlighting progress, risks, and issues. Job Qualifications REQUIRED EDUCATION: Bacheloru2019s degree or equivalent combination of education and experience REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: u2022 2+ years of program and/or project management experience in risk adjustment and/or quality u2022 2+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems u2022 2+ years of data analysis experience utilizing technical skillsets and resources to answer nuanced Risk and Quality questions posed from internal and external partners u2022 Familiarity with running queries in Microsoft Azure or SQL server u2022 Healthcare experience and functional risk adjustment and/or quality knowledge u2022 Mastery of Microsoft Office Suite including Excel and Project u2022 Experience partnering with various levels of leadership across complex organizations u2022 Strong quantitative aptitude and problem solving skills u2022 Intellectual agility and ability to simplify and clearly communicate complex concepts u2022 Excellent verbal, written and presentation capabilities u2022 Energetic and collaborative PREFERRED EDUCATION: Graduate degree or equivalent combination of education and experience PREFERRED EXPERIENCE: u2022 Knowledge of, and familiarity with, NCQA, CMS, and State regulatory submission requirements u2022 Experience working in a cross-functional, highly matrixed organization u2022 SQL proficiency u2022 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 - $155,508 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-04