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. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Skills Required
- At least 8 years of managed care experience, including risk adjustment or quality-related experience supporting Medicaid, Medicare, and/or Marketplace programs, or an equivalent combination of education and experience.
- At least 3 years of management or leadership experience.
- Proficiency with risk adjustment methodologies.
- Quality and risk operations 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 collaboratively in a highly matrixed organization.
- Ability to collaborate with stakeholders and drive or influence change and initiatives.
- Project management experience.
- Excellent verbal, written, and presentation skills.
- Proficiency with Microsoft Office Suite and applicable software programs, with the ability to learn new information systems.
- Strong quality and risk adjustment project-related experience.
- Prior experience with Centers for Medicare and Medicaid Services risk adjustment initiatives.
- Advanced knowledge and understanding of HEDIS and NCQA.
- Certified Professional in Healthcare Quality (CPHQ).
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
