Talent.com
Risk & Quality Performance Manager (Remote)

Risk & Quality Performance Manager (Remote)

Atlanta StaffingAtlanta, GA, US
1 day ago
Job type
  • Full-time
  • Remote
Job description

Risk & Quality Performance Manager

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
  • 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. Pay Range : $77,969 - $155,508 / ANNUAL

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
  • Create a job alert for this search

    Performance Manager • Atlanta, GA, US

    Related jobs
    • Promoted
    Risk Manager

    Risk Manager

    Holder ConstructionAtlanta, GA, US
    Full-time
    Holder Construction has an exciting opportunity for an experience Risk Management & Insurance professional to join our team as a Risk Manager. Required Education, Experience, And Qualifications....Show moreLast updated: 1 day ago
    • Promoted
    Managed Review Project Manager

    Managed Review Project Manager

    TransPerfectAtlanta, GA, US
    Full-time
    TransPerfect is the world's largest provider of language services and technology solutions for global business.From offices in over 100 cities on six continents, TransPerfect offers a full rang...Show moreLast updated: 22 days ago
    • Promoted
    Environment, Health and Safety Manager

    Environment, Health and Safety Manager

    SAVI EHSPeachtree City, GA, US
    Full-time
    Environmental, Health & Safety (EHS) Manager – Data Center Project.Local candidates preferred, per diem available for travelers. Full-Time (Short-Term Assignment).SAVI EHS is seeking an ex...Show moreLast updated: 12 days ago
    • Promoted
    Senior Manager - Digital Fraud and Loss Trend Analytics (REMOTE VA, MD, NC, PA, GA)

    Senior Manager - Digital Fraud and Loss Trend Analytics (REMOTE VA, MD, NC, PA, GA)

    Atlantic Union BankAlpharetta, GA, United States
    Remote
    Full-time
    The Senior Manager of Digital Fraud and Fraud Trend Analysis role will lead efforts to prevent and investigate digital Regulation E fraud, oversee fraud loss trend analysis, and drive implementatio...Show moreLast updated: 15 days ago
    • Promoted
    Plan Review Consultant

    Plan Review Consultant

    FMPEACHTREE CORNERS, Georgia, United States
    Full-time
    FM is a leading property insurer of the world's largest businesses, providing more than one-third of FORTUNE 1000- size companies with engineering-based risk management and property insurance solut...Show moreLast updated: 1 day ago
    • Promoted
    Operations Manager - Flow Center - Hampton, GA

    Operations Manager - Flow Center - Hampton, GA

    TargetHampton, Georgia, United States of America
    Full-time
    Pay is based on several factors which vary based on position.These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Tar...Show moreLast updated: 30+ days ago
    • Promoted
    Fully Remote Survey Participant

    Fully Remote Survey Participant

    Prime InsightsMcDonough, GA, US
    Remote
    Full-time
    Join thousands of members already earning with top-paying surveys and offers.Get started today and enjoy competitive rewards, fast payouts with no waiting periods, and the flexibility to participat...Show moreLast updated: 1 day ago
    • Promoted
    Safety and Compliance Director

    Safety and Compliance Director

    AirgasLawrenceville, GA, US
    Full-time
    Airgas is hiring for a Safety and Compliance Director in Lawrenceville, GA!.Strong passion for fostering an environment of Diversity, Inclusion and Respect. Experience with developing, contributing,...Show moreLast updated: 22 days ago
    • Promoted
    Survey Taker : Earn up to $25 per survey (Remote)

    Survey Taker : Earn up to $25 per survey (Remote)

    Earn HausLocust Grove, GA, US
    Remote
    Full-time +1
    Looking for people to participate in taking online surveys for Fortune 500 brands.All you need to do is complete online surveys by sharing your opinion. You will help influence brand decisions on se...Show moreLast updated: 4 days ago
    • Promoted
    Compensation Manager

    Compensation Manager

    Jackson HealthcareAlpharetta, GA, US
    Permanent
    Jackson Healthcare and our family of companies provide healthcare systems, hospitals and medical facilities of all sizes with the skilled and specialized labor and technologies they need to deliver...Show moreLast updated: 30+ days ago
    • Promoted
    Cyber Security Risk Management Engineer

    Cyber Security Risk Management Engineer

    ViasatDuluth, GA, United States
    Full-time
    At Viasat, we're on a mission to deliver connections with the capacity to change the world.For more than 35 years, Viasat has helped shape how consumers, businesses, governments and militaries arou...Show moreLast updated: 29 days ago
    • Promoted
    Restaurant Assistant Manager

    Restaurant Assistant Manager

    Zaxby'sHampton, GA, US
    Full-time
    As the team at Zaxbys expands, we're saving a seat for you!.To our guests, Zaxbys is more than just a place to eat its a place to have fun, spend time with friends, and enjoy great food.To our tea...Show moreLast updated: 1 day ago
    • Promoted
    • New!
    Reserve Entomologist

    Reserve Entomologist

    United States ArmyMcdonough, GA, United States
    Full-time
    THE ARMY HEALTH CARE ADVANTAGE As a member of the Army health care team, you’ll receive benefits that you won’t be able to get in a civilian career. Challenging Work Feel inspired with great case di...Show moreLast updated: 14 hours ago
    • Promoted
    Remote Side Hustle Evaluator - Flexible Online Gig Work

    Remote Side Hustle Evaluator - Flexible Online Gig Work

    Finance BuzzPeachtree City, Georgia, US
    Remote
    Temporary
    Are you looking to earn extra income from the comfort of your home? We're seeking motivated individuals to explore and test a variety of remote side hustle opportunities featured on FinanceBuzz.Thi...Show moreLast updated: 30+ days ago
    • Promoted
    Remote Opportunity - Explore Side Hustles & Earn Extra Income

    Remote Opportunity - Explore Side Hustles & Earn Extra Income

    Finance BuzzGriffin, Georgia, US
    Remote
    Temporary
    FinanceBuzz is looking for everyday people to test-drive some of the most popular online money-making methods.This remote opportunity lets you earn extra income while reviewing real, flexible side ...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Pricing & Market Intelligence Manager

    Pricing & Market Intelligence Manager

    Rinnai America CorporationPeachtree City, GA, US
    Full-time
    Creating A Healthier Way of Living.Rinnai America Corporation is the leader in tankless water heating, a technology that is growing rapidly as businesses and homes “yank the tank” and c...Show moreLast updated: 11 hours ago
    • Promoted
    Construction Project Manager

    Construction Project Manager

    2020 Search PartnersPeachtree City, GA, US
    Full-time
    One to five years of direct work experience in project management capacity, proven experience in people management, strategic planning, risk management, and change management.Experience in general ...Show moreLast updated: 30+ days ago
    • Promoted
    Public Safety Manager (Full-Time)

    Public Safety Manager (Full-Time)

    Six Flags Over GeorgiaAustell, GA, US
    Full-time
    Six Flags Over Georgia is seeking a dynamic and energetic leader to lead our Security, Loss Prevention, Risk Management, and Parking Lot Departments! This position is directly responsible for ensur...Show moreLast updated: 1 day ago