Job Description

JOB DESCRIPTION Job Summary

Provides subject matter expertise for Molina’s risk and quality performance solutions (RQS) team. Collaborates with various departments and stakeholders across the enterprise to plan, coordinate, and manage resources, and execute quality and risk performance improvement initiatives in alignment with strategic objectives.

Essential Job Duties

• Collaborates with health plan risk and quality leaders to improve outcomes by managing risk and quality data collection strategy, analytics, and reporting for the following: risk/quality rate trending and forecasting, provider risk/quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement.

• Monitors quality-related projects from inception through successful delivery.

• Oversees risk/quality data ingestion activities and strategies to optimize completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact.

• Proactively communicates quality/risk issues to stakeholders and leadership.

• Draws actionable quality/risk-related conclusions and recommends performance improvement initiatives.

• Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines, and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success.

• Partners with cross-functional teams to ensure data quality delivery through sequential transformations, and identifies opportunities to close quality and risk care gaps.

• Creates, reviews, and approves quality-related program documentation - including plans, reports, and records, and ensures information is accessible for quality teams throughout the enterprise.

• Proactively communicates regular quality/risk-related status reports to stakeholders - highlighting progress, risks, and issues.

• Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.

Required Qualifications

• At least 3 years of program/project management experience in risk adjustment and/or quality, including experience supporting HEDIS activities and risk adjustment targeting and reporting, or equivalent combination of relevant education and experience.
• Health care experience and functional risk adjustment/quality knowledge.
• Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server.
• Intellectual agility and ability to simplify and clearly communicate complex concepts.
• Proficiency with data analysis, manipulation, interpretation and reporting.
• Strong quantitative aptitude, critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Project management experience.
• Effective verbal, written and presentation communication skills.
• Microsoft Office suite (including Excel) and applicable software programs proficiency, and ability to learn/navigate new software programs.

Preferred Qualifications

• Intermediate knowledge/experience related to National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS), and state-specific regulatory submission requirements.
• Microsoft SQL proficiency.
• Knowledge of health care claim elements: Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine – Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), National Provider Identifiers (NPIs), Taxpayer Identification Numbers (TINs), etc.
• Experience working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
• Project Management Professional (PMP).
• Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V