[Hiring] Lead National Quality Performance Manager @Molina Healthcare

Role Description

Provides consultant level support for Molina’s quality performance solutions team. Owns and drives the most complex quality performance initiatives, provides functional guidance to peers, and partners with leadership to ensure alignment with quality strategies, regulatory requirements, and enterprise priorities.

• Leads execution of complex quality data analysis and reporting initiatives.
• Collaborates with health plan quality leaders and cross-functional partners.
• Supports quality rate trending, provider performance measurement, CAHPS and survey analytics, health equity and SDOH initiatives, and external vendor engagement.
• Ensures quality programs are successfully delivered on time, within scope, and within resource constraints.
• Provides functional guidance and subject matter expertise for quality programs and projects.
• Oversees execution of quality data ingestion activities.
• Partners with technical teams to resolve complex data quality issues impacting EHR, HIE, and supplemental data.
• Serves as an escalation point for complex quality issues.
• Drives resolution through advanced data analysis, project management, and cross-functional collaboration.
• Leads execution of complex quality assignments and program changes.
• Ensures alignment with program goals and provides regular updates to leadership on progress, risks, and recommendations.
• Proactively communicates quality issues to stakeholders and leadership.
• Draws actionable quality-related conclusions and recommends performance improvement initiatives.
• Ensures compliance with all quality-related regulatory audit guidelines.
• Implements solutions to maximize HEDIS audit success.
• Partners with cross-functional teams to ensure data quality delivery.
• Ensures that program deliverables meet all quality standards and regulatory requirements.
• Creates and reviews complex quality-related program documentation.
• Proactively communicates regular quality-related status reports to stakeholders.
• Meets customer expectations and requirements, establishes, and maintains effective relationships.
• Represents as quality team subject matter expert (SME).
• Provides functional training, mentoring, and knowledge sharing to quality team members.
• Promotes collaboration and knowledge sharing within the quality team.

Qualifications

• At least 5 years of program/project management experience in quality, including experience supporting HEDIS activities.
• Comprehensive mastery of the drivers of value in managed health care.
• In-depth knowledge of quality and the health care industry.
• Extensive knowledge of health care claim elements including CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX Codes, NPIs, and TINs.
• Experience running queries in Microsoft Azure or SQL server.
• Ability to assess impact cross-functionally and identify costs/benefits.
• Intellectual agility and ability to simplify 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.
• Strong project management experience.
• Strong verbal, written, and presentation communication skills.
• Proficiency in Microsoft Office suite and applicable software programs.

Requirements

• Experience leading in a cross-functional, highly matrixed organization.
• History of excelling in roles impacting quality.
• Advanced knowledge/experience related to NCQA, HEDIS, CMS, and state-specific regulatory submission requirements.
• Microsoft Azure Databricks and SQL mastery.
• Project Management Professional (PMP) certification.
• Six Sigma Green Belt or Black Belt certification, and/or comparable coursework.

Benefits

• Competitive benefits and compensation package.
• Equal Opportunity Employer (EOE) M/F/D/V.