Molina Healthcare

Program Director, National Risk & Quality Solutions (Remote)

Molina Healthcare$110K — $130K *
US-AnywhereRemote in Arizona, US
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • 8+ years of managed care experience, especially in risk adjustment and quality for Medicaid, Medicare, or Marketplace.
  • 3+ years in a management or leadership role.
  • Expertise in risk adjustment methodologies and quality improvement processes.
  • Strong data analysis and interpretation skills with attention to detail.
  • Ability to work effectively in a cross-matrixed environment.

Responsibilities

  • Provide risk and quality support for state health plans, ensuring alignment with goals.
  • Act as a subject matter expert on risk and quality, leading critical industry programs.
  • Identify and escalate barriers in risk/quality initiatives to leadership for resolution.
  • Support development of business cases for new risk/quality programs.
  • Collaborate with teams to coordinate risk and quality activities.

Benefits

  • Comprehensive healthcare benefits for employees and their families.
  • Opportunities for professional development and certification support.
  • Collaborative and supportive workplace culture.
Full Job Description
Job Description

JOB DESCRIPTION Job Summary
Provides deep subject matter expertise for enterprise Molina risk and quality solutions (RQS) activities. Collaborates with health plan risk and quality leaders to support implementation of best quality/risk practices for optimal performance. Ensures that all RQS action plans are complete, accurate and reflect objectives necessary to achieve established risk/quality performance goals.

Essential Job Duties
• Provides risk and quality support to a selection of state health plans; leverages established risk and quality solutions (RQS) best practices to support health plan achievement of risk/quality goals, with oversight senior quality/risk adjustment leadership.
• Serves as a risk/quality industry subject matter expert to functional areas/health plans, and leads risk/quality-related programs to meet critical needs.
• Escalates gaps and barriers in risk/quality programs/initiatives implementation and compliance to leadership; partners with the execution team for resolution and barrier removal impeding health plan execution.
• Represents in a consultative role, supporting development of business case methodologies for incremental risk/quality programs; develops and coordinates implementation of business strategies.
• Collaborates and facilitates risk/quality-related activities with corporate/health plan teams.

Required Qualifications
• At least 8 years of managed care experience, including risk adjustment/quality-related experience supporting Medicaid, Medicare, and/or Marketplace, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Proficiency with risk adjustment methodologies.
• Quality/risk operational and process improvement experience.
• Proficiency with data analysis, manipulation and interpretation.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Ability to collaborate and drive/influence change and initiatives with internal/external stakeholders.
• Project management experience.
• Excellent verbal/written communication skills, and presentation skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications
• Strong quality/risk adjustment project-related experience.
• Prior experience with Centers for Medicare and Medicaid Services (CMS) risk adjustment-related initiatives.
• Advanced knowledge and understanding of HEDIS and NCQA.
• Certified Professional in Healthcare Quality (CPHQ).

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
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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