Risk & Quality Performance Manager (Remote)
Not Disclosed•Full-TimeOn-site
location_on791, West River Heights Avenue, River Haven, Tampa, Hillsborough County, Florida, 33603, United States
The Risk & Quality Performance Manager supports Molina's Risk & Quality Solutions (RQS) team. This group is dedicated to executing performance improvement initiatives that align with RQS's strategic objectives, ensuring high standards of care and data integrity across the organization.
This position serves as a strategic partner to Health Plan Risk and Quality leaders, focusing on improving outcomes through the management of data collection strategies, analytics, and reporting. You will oversee the full lifecycle of projects, from inception to successful delivery, while optimizing the ingestion of EHR, HIE, and supplemental data to ensure completeness and accuracy.
In this role, you will navigate complex data landscapes to identify opportunities for closing quality and risk care gaps. You will collaborate with internal and external partners to draw actionable conclusions, proactively communicate risks to leadership, and ensure compliance with regulatory audit guidelines to maximize national HEDIS audit success. The role requires building trust and effective relationships with stakeholders while maintaining rigorous documentation standards.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. We are committed to creating a diverse and inclusive environment for all employees and consider qualified applicants regardless of background.
Work model: On-site
791, West River Heights Avenue, River Haven, Tampa, Hillsborough County, Florida, 33603, United States
Tampa, Florida
Graduate degree or equivalent combination of education and 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. PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework.
Skills: Hedis, Cahps, Sdoh, SQL, Microsoft Azure, Microsoft Office Suite, Excel, Project, Ncqa, CMS.
Education: Bachelor's degree or equivalent combination of education and experience; Graduate degree or equivalent combination of education and experience.
