Program Director, National Risk & Quality Solutions

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

Originally posted on Himalayas