Program Director, National Risk & Quality Solutions

Role Summary

JOB DESCRIPTION Job Summary

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.

Requirements

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