About this role.
Molina Healthcare is seeking a Risk & Quality Performance Manager to join their Risk & Quality Solutions team. The role involves collaborating with health plan leaders to improve risk and quality outcomes through data strategy, analytics, and reporting. Responsibilities include managing projects, overseeing data ingestion, ensuring compliance with regulatory audits, and identifying care gaps. Candidates need a bachelor's degree, 2+ years of project management in risk adjustment/quality, and data analysis skills. Preferred qualifications include a graduate degree, SQL proficiency, and certifications like PMP or Six Sigma.
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Core skills
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Cover letter sample
I am excited to apply for the Risk & Quality Performance Manager position at Molina Healthcare. With over 2 years of experience in risk adjustment and quality improvement, I have a proven track record of driving data-driven initiatives that enhance outcomes. My expertise in HEDIS, regulatory compliance, and project management aligns well with the responsibilities outlined in the job description.
In my previous role, I successfully collaborated with cross-functional teams to improve risk score accuracy and quality measures, resulting in a 15% increase in HEDIS scores. I am proficient in SQL and Microsoft Azure, enabling me to analyze complex data sets and provide actionable insights.
I am particularly drawn to Molina's mission of providing quality healthcare to underserved populations. I am eager to bring my analytical skills and collaborative approach to support the RQS team's strategic objectives.
Thank you for considering my application. I look forward to the opportunity to discuss how my background can contribute to Molina's success.
Sample interview questions
In my previous role, I managed HEDIS data collection and reporting, identifying gaps in care and implementing interventions that improved compliance rates. For example, I led a project that increased colorectal cancer screening rates by 10% through targeted outreach and provider education.
I use a structured approach, starting with clear goal setting and stakeholder alignment. I create detailed project plans with milestones and communicate regularly to ensure transparency. I also adapt to feedback and adjust priorities as needed to keep projects on track.
While analyzing risk adjustment data, I noticed discrepancies in diagnosis coding from a vendor. I collaborated with the vendor and internal teams to identify the root cause, implemented validation checks, and improved data accuracy by 20%.
I stay updated on CMS and NCQA requirements and create a compliance roadmap with deadlines. I conduct internal audits, train staff on documentation standards, and work with auditors to address any findings promptly.
I use SQL to extract and manipulate data from databases, creating queries to analyze risk scores, quality measures, and provider performance. For instance, I wrote SQL scripts to identify members with care gaps and generated reports for outreach teams.
Job Description
Job Summary
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.
Job Duties
• 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.
Job Qualifications
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
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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.
Annual salary information is not provided for this position. Explore salary ranges for similar roles in our Salary Directory ›
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