Molina Healthcare

Manager, National Risk & Quality Solutions (Remote)

Molina Healthcare • $110K — $130K *
US-AnywhereRemote in United States
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • 7+ years of program/project management experience in quality, especially with HEDIS activities.
  • 1+ year of management/leadership experience.
  • In-depth knowledge of health care quality drivers and the industry as a whole.
  • Extensive familiarity with numerous healthcare claim coding systems and terminologies.
  • Proficiency in SQL and Microsoft Azure for querying and data management.
  • Exceptional data analysis and reporting skills.

Responsibilities

  • Manage and lead the Quality Systems team to meet performance expectations.
  • Support the annual quality data submission process for regulatory compliance.
  • Design and manage data strategies to enhance data ingestion activities.
  • Collaborate with quality leaders to improve program performance through analytics.
  • Oversee quality project planning and execution, ensuring compliance and timely delivery.
  • Identify and address barriers in project plans with effective mitigation strategies.
  • Conduct regular reviews and audits to maintain quality standards.

Benefits

  • Comprehensive health insurance options.
  • Retirement savings plan with company match.
  • Professional development and training opportunities.
  • Collaborative work culture promoting team success.
  • Flexible working arrangements available.
Full Job Description
Job Description

Job Description

Job Summary

Leads and manages Quality Systems performance managers, demonstrating accountability for people performance, delivery outcomes, and execution of quality system initiatives. Oversees a portfolio of quality data and performance improvement activities, ensuring teams are resourced, aligned, and operating in accordance with quality strategies, regulatory requirements, and enterprise priorities.

Job Duties
  • Manages the Quality Systems team, including setting expectations, monitoring performance, providing coaching and feedback, and ensuring alignment with quality strategies and department specific goals.
  • Supports the annual quality data submission process, including National Committee for Quality Assurance (NCQA) and state regulatory submissions.
  • Manages, designs, and develops data-focused strategies to improve completeness and accuracy of data ingestion activities including supplemental and Health Information Exchange (HIE) data.
  • Collaborates with corporate quality leaders and health plans to improve program performance by supporting development of meaningful reporting and analytics including but not limited to: quality rate trending and forecasting, provider quality performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other survey analytics, and health equity.
  • Oversees development of quality project plans and schedules, assigns resources, and ensures deliverables are met on time, within scope, and in compliance with regulatory requirements.
  • Identifies potential barriers to quality project plans and develops mitigation strategies.
  • Ensures complex problems are addressed and resolved by the team through effective prioritization, escalation, and cross-functional collaboration.
  • Draws actionable conclusions and collaborates with cross-functional teams to present recommendations/solutions to identify quality issues.
  • Conducts regular quality-related reviews and audits to maintain high standards of performance.
  • Addresses issues/discrepancies promptly to ensure quality program success.
  • Develops data quality strategies and solutions to close quality care gaps.
  • Communicates effectively and consistently with leadership and key stakeholders regarding portfolio status, risks, dependencies, and recommended remediation approaches.
  • Fosters a collaborative and high-performing team and promotes professional development and knowledge sharing within the team.
  • Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality department-specific goals.


Job Qualifications

REQUIRED QUALIFICATIONS:
  • At least 7 years of program/project management experience in quality, including experience supporting HEDIS activities targeting and reporting, or equivalent combination of relevant education and experience.
  • At least 1 year of management/leadership experience.
  • Comprehensive mastery of the drivers of value in managed health care, and in-depth knowledge of quality and the health care industry.
  • Extensive knowledge and mastery of the nuances of health care claim elements including: 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), and Taxpayer Identification Numbers (TINs).
  • Experience running queries in Microsoft Azure or Structured Query Language (SQL) server.
  • Ability to assess impact cross-functionally, identify costs/benefits to upstream and downstream stakeholders, and solution benefits to multiple business areas.
  • 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.
  • High attention to detail and organizational skills.
  • History of partnering with various levels of leadership across complex organizations, and ability to work cross-collaboratively in a highly matrixed organization.
  • Strong 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:
  • Experience leading in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.
  • History of excelling in roles impacting quality.
  • Advanced 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 Azure Databricks and SQL mastery.
  • 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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Healthcare
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ
MOH
* Ladders Estimates

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