Risk & Quality Performance Manager | JobSetuu

Description

Job Overview

• Source: Jobicy

Job Description

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

#PJCorp

#LI-AC1

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.

Expert Career Tips for Risk & Quality Performance Manager Roles

To succeed in a competitive market as a Risk & Quality Performance Manager, you need more than just technical skills. Here are some expert strategies to elevate your profile:

• Build a Strong Portfolio: For technical roles, a clean GitHub or a personal project site is essential. For non-technical roles, a case study portfolio demonstrating problem-solving and impact is equally valuable. Show, don't just tell, what you have achieved in your previous positions.
• Master the Narrative: When interviewing, use the STAR method (Situation, Task, Action, Result) to structure your answers. Quantify your results wherever possible—mentioning "increased efficiency by 20%" is much more impactful than saying "improved efficiency."
• Continuous Learning: The industry moves fast. Whether it's staying updated with the latest AI tools or mastering a new management methodology, continuous professional development is key. Consider obtaining industry-recognized certifications that align with Risk & Quality Performance Manager requirements.
• Networking: Connect with other professionals in similar roles. Join online communities, attend webinars, and engage in meaningful discussions on professional social networks. Often, the best opportunities come through referrals and community engagement.
• Soft Skills Matter: Communication, empathy, and leadership are often the deciding factors between two equally qualified technical candidates. Cultivate these skills as they are universally valued across all industries and seniority levels.

Additionally, research the specific company's culture and values. Tailoring your application to show how you align with their mission can significantly increase your chances of moving forward in the process.

Salary & Compensation

Salary not disclosed; typically competitive for the role.

Work Arrangement

Type: On-Site

Standard business hours at the office.

Comprehensive Application Strategy & Hiring Process

Applying for a new role is a marathon, not a sprint. Follow this strategic approach to maximize your success rate:

1. Initial Research & Tailoring

Don't send the same resume to every employer. Spend at least 30 minutes researching the company. Look for recent news, their product roadmap, and their team structure. Modify your summary and core competencies to reflect the specific keywords found in the job description.

2. The Perfect Cover Letter

If the application allows for a cover letter, use it to tell a story that your resume cannot. Explain why you are passionate about this specific company and how your unique background makes you the perfect fit for the challenges they are currently facing.

3. Navigating the Multi-Stage Interview

Most modern hiring processes involve 3-5 stages. This typically includes a recruiter screen, a technical or skill-based assessment, a peer interview, and a final leadership round. Prepare for each stage differently: focus on enthusiasm and fit for the recruiter, technical depth for the assessment, and strategic vision for the leadership round.

4. Post-Interview Follow-Up

Always send a personalized thank-you note within 24 hours of each interview. Reference a specific topic discussed during the call to demonstrate your active listening and genuine interest in the role.

By following these steps, you demonstrate a high level of professionalism and attention to detail that sets you apart from the average applicant.

Typical Interview Process

1. Resume screening
2. HR call
3. Skill interview
4. Final manager interview
5. Offer

Tip: Research the company's products and culture.

Global Market Intelligence & Relocation Insights

At JobSetuu, we specialize in helping talent navigate the global job market. Here is what you need to know about the current landscape in Global and beyond:

The demand for skilled professionals is increasingly borderless. For roles based in Global, understanding the local cost of living, visa requirements (if applicable), and cultural nuances is vital. If this is a remote role, consider the time zone alignment and the asynchronous communication culture of the hiring organization.

Relocation Support: Many forward-thinking companies offer relocation packages that include moving stipends, temporary housing, and legal assistance with work permits. When evaluating an offer, look beyond the base salary—consider the total compensation package, including equity, bonuses, and healthcare benefits.

Work-Life Balance Trends: Hybrid and remote work have become standard in many regions. Research the local labor laws and common practices regarding work hours and vacation time to ensure the role aligns with your lifestyle goals.

Leveraging JobSetuu's tools can help you compare salaries across different cities and understand the "purchasing power" of your potential offer, ensuring you make an informed decision for your long-term career path.

Skills & Competency Roadmap for Professional Development

To remain competitive in Professional Development, we recommend focusing on the following core competencies over the next 12-18 months:

• Technical Mastery: Deepen your expertise in the core tools and languages relevant to your field. For developers, this might be cloud architecture; for marketers, it might be data-driven attribution modeling.
• AI Augmentation: Learn how to leverage generative AI and automation tools to increase your productivity. Understanding how to integrate these technologies into your workflow is becoming a non-negotiable skill.
• Leadership & Strategy: Even in individual contributor roles, the ability to think strategically and lead projects from inception to completion is highly valued. Focus on stakeholder management and high-level project planning.
• Data Literacy: The ability to interpret data and use it to drive decisions is essential across all business functions. Familiarize yourself with data visualization and basic analytical concepts.

By investing in these areas, you not only prepare yourself for the role you are applying for today but also build a resilient foundation for the opportunities of tomorrow.

Apply via JobSetuu

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