Job Location : Rochester,NY, USA
The Risk & Quality Performance Manager position will support Molina's 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 RQS's strategic objectives.
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.
Monitor projects from inception through successful delivery.
Oversee Risk/Quality data ingestion activities and strategies to optimize completeness and accuracy of EHR/HIE and supplemental data.
Meet customer expectations and requirements, establish, and maintain effective relationships and gain their trust and respect.
Draw actionable conclusions, and make decisions as needed while collaborating with other teams.
Ensure compliance with all regulatory audit guidelines by adhering to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success.
Partner with other teams to ensure data quality through sequential transformations and identify opportunities to close quality and risk care gaps.
Proactively communicate risks and issues to stakeholders and leadership.
Create, review, and approve program documentation, including plans, reports, and records.
Ensure documentation is updated and accessible to relevant parties.
Proactively communicate regular status reports to stakeholders, highlighting progress, risks, and issues.
REQUIRED EDUCATION:
Bachelor's degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
2+ years of program and/or project management experience in risk adjustment and/or quality
2+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems
2+ years of data analysis experience utilizing technical skillsets and resources to answer nuanced Risk and Quality questions posed from internal and external partners
Familiarity with running queries in Microsoft Azure or SQL server
Healthcare experience and functional risk adjustment and/or quality knowledge
Mastery of Microsoft Office Suite including Excel and Project
Experience partnering with various levels of leadership across complex organizations
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
PREFERRED EDUCATION:
Graduate degree or equivalent combination of education and experience
PREFERRED 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.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework desired