Manager, National Risk & Quality Solutions

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.

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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.

Originally posted on Himalayas