30 applicantsPosted by Agency

Company

Molina Healthcare · 16 hours ago

Manager, Risk & Quality Systems (Remote)

Arizona, United States

Full-time

Remote

Mid, Senior Level

$88K/yr - $207K/yr

8+ years exp

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Responsibilities

Manages Risk and Quality Systems’ project and/or program managers and ensures team remains aligned with RQS strategies and goals.

Supports the annual quality data submissions (NCQA and state regulatory submissions).

Manages, designs, and develops data-focused strategies to improve completeness and accuracy of data ingestion activities including supplemental and HIE data.

Collaborates with Risk & Quality leaders in RQS and health plans to improve program performance by supporting development of meaningful reporting and analytics including but not limited to: Risk/Quality rate trending and forecasting, provider Risk/Quality performance, CAHPS and other survey analytics, and health equity.

Develops and maintains detailed and comprehensive project plans, schedules and assigns resources to ensure deliverables are timely, meet regulatory requirements, and are high quality.

Identifies potential risks/barriers to project plans, etc. and develop mitigation strategies.

Resolves complex problems through project management, data analytics, and stakeholder collaboration.

Draws actionable conclusions, and makes decisions as needed while collaborating with other teams.

Conducts regular reviews and audits to maintain high standards of performance.

Addresses any issues or discrepancies promptly to ensure program success.

Develops data quality strategies and solutions to close risk and quality care gaps.

Communicate effectively and consistently with key stakeholders, including reporting risks and issues to stakeholders with recommended solutions.

Prepares and presents regular status reports to stakeholders, highlighting progress, risks, and issues.

Fosters a collaborative and high-performing team environment.

Promotes professional development and knowledge sharing within the team.

Mentors team members to develop their professional Risk/Quality expertise.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Program managementRisk adjustmentData analysisHEDIS engine activityMicrosoft AzureSQL serverMicrosoft Office SuiteHealthcare experienceHealthcare industry knowledgeQuantitative aptitudeHealthcare claim elementsPMP certificationSix Sigma Green BeltSix Sigma Black BeltPresentation capabilities

Required

Bachelor’s degree or equivalent combination of education and experience

8+ years of program and/or project management experience in risk adjustment and/or quality

4-6 years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems

4-6 years of data analysis experience utilizing technical skillsets and resources to answer nuanced risk and quality questions posed from internal and external partners

People management experience that demonstrates excellent leadership skills

Expertise 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

Accomplished history of partnering with various levels of leadership across complex organizations.

Comprehensive mastery of the drivers of value in managed health care as well as in-depth knowledge of the healthcare industry

Expert-level ability to think cross-functionally, identifying cost/benefits to upstream and downstream stakeholders, and solutioning which sustains benefits to multiple groups and business areas

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

Extensive knowledge and mastery of the nuances of healthcare claim elements: CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc.

Preferred

Graduate degree or equivalent combination of education and experience

Experience supporting leadership and operating in a leadership role while working in a cross-functional, highly matrixed organization

SQL mastery

History of excelling in roles impacting both risk adjustment and quality

PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework desired

Benefits

Competitive benefits and compensation package

Company

Molina Healthcare

Glassdoor

3.4

Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.

Founded in 1980

Long Beach, California, USA

10001+ employees

https://careers.molinahealthcare.com

H1B Sponsorship

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2023 (33)

2022 (36)

2021 (33)

2020 (60)