National Risk & Quality Performance Manager

• Collaborates with health plan risk and quality leaders to improve outcomes by managing risk and quality data collection strategy, analytics, and reporting for the following: risk/quality rate trending and forecasting, provider risk/quality measurement performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and survey analytics, health equity and social determinants of health (SDOH), and external vendor engagement.

• Monitors quality-related projects from inception through successful delivery.

• Oversees risk/quality data ingestion activities and strategies to optimize completeness and accuracy of electronic health record (EHR)/health information exchange (HIE) and supplemental data impact.

• Proactively communicates quality/risk issues to stakeholders and leadership.

• Draws actionable quality/risk-related conclusions and recommends performance improvement initiatives.

• Ensures compliance with all quality-related regulatory audit guidelines by adhering to roadmap of deliverables and timelines, and implements solutions to maximize national Healthcare Effectiveness Data and Information Set (HEDIS) audit success.

• Partners with cross-functional teams to ensure data quality delivery through sequential transformations, and identifies opportunities to close quality and risk care gaps.

• Creates, reviews, and approves quality-related program documentation - including plans, reports, and records, and ensures information is accessible for quality teams throughout the enterprise.

• Proactively communicates regular quality/risk-related status reports to stakeholders - highlighting progress, risks, and issues.

• Meets customer expectations and requirements, establishes, and maintains effective relationships and gains trust and respect.

Required Qualifications

• At least 3 years of program/project management experience in risk adjustment and/or quality, including experience supporting HEDIS activities and risk adjustment targeting and reporting, or equivalent combination of relevant education and experience.

• Health care experience and functional risk adjustment/quality knowledge.

• Familiarity with running queries in Microsoft Azure or Structured Query Language (SQL) server.

• 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.

• Attention to detail and organizational skills.

• Ability to work cross-collaboratively in a highly matrixed organization.

• Project management experience.

• Effective 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

• Intermediate 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 SQL proficiency.

• Knowledge of health care claim elements: 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), Taxpayer Identification Numbers (TINs), etc.

• Experience working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs.

• Project Management Professional (PMP).

• Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

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

Job Info

Job Identification: 2037614

Job Category: Quality & Risk Adjustment

Posting Date: 2026-05-21T16:54:03 00:00

Job Schedule: Full time