Manager, National Risk & Quality Solutions - NCQA
# Manager, National Risk & Quality Solutions - NCQA **Molina Healthcare** · United States · `Remote` · `Full Time` 💼 **Уровень роли:** `Manager` 🕒 **Статус:** *Опубликовано: сегодня* · *Источник: Himalayas (JSON API)* --- ### Top Skills & Match 🎯 **Ключевой стек роли:** `[QA-Manager]` `[Healthcare-Quality-Manager]` `[Quality-Director]` `[Risk-Adjustment-Manager]` `[HEDIS-Specialist]` `[Quality-Risk-Management-Manager]` `[NCQA-Program-Manager]` `[Quality-And-Compliance-Manager]` `[Quality-Compliance-Manager]` --- ### About the Role Job Description Job Summary Leads and manages Quality Systems performance managers, demonstrating accountability for people performance, delivery outcomes, and execution of quality system initiatives. Oversees a portfolio of quality data and performance improvement activities, ensuring teams are resourced, aligned, and operating in accordance with quality strategies, regulatory requirements, and enterprise priorities. Job Duties - Manages the Quality Systems team, including setting expectations, monitoring performance, providing coaching and feedback, and ensuring alignment with quality strategies and department specific goals. - Supports the annual quality data submission process, including National Committee for Quality Assurance (NCQA) and state regulatory submissions. - Manages, designs, and develops data-focused strategies to improve completeness and accuracy of data ingestion activities including supplemental and Health Information Exchange (HIE) data. - Collaborates with corporate quality leaders and health plans to improve program performance by supporting development of meaningful reporting and analytics including but not limited to: quality rate trending and forecasting, provider quality performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other survey analytics, and health equity. - Oversees development of quality project plans and schedules, assigns resources, and ensures deliverables are met on time, within scope, and in compliance with regulatory requirements. - Identifies potential barriers to quality project plans and develops mitigation strategies. - Ensures complex problems are addressed and resolved by the team through effective prioritization, escalation, and cross-functional collaboration. - Draws actionable conclusions and collaborates with cross-functional teams to present recommendations/solutions to identify quality issues. - Conducts regular quality-related reviews and audits to maintain high standards of performance. - Addresses issues/discrepancies promptly to ensure quality program success. - Develops data quality strategies and solutions to close quality care gaps. - Communicates effectively and consistently with leadership and key stakeholders regarding portfolio status, risks, dependencies, and recommended remediation approaches. - Fosters a collaborative and high-performing team and promotes professional development and knowledge sharing within the team. - Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality department-specific goals. Job Qualifications REQUIRED QUALIFICATIONS: - At least 7 years of program/project management experience in quality, including experience supporting HEDIS activities targeting and reporting, or equivalent combination of relevant education and experience. - At least 1 year of management/leadership experience. - Comprehensive mastery of the drivers of value in managed health care, and in-depth knowledge of quality and the health care industry. - Extensive knowledge and mastery of the nuances of health care claim elements including: 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), and Taxpayer Identification Numbers (TINs). - Experience running queries in Microsoft Azure or Structured Query Language (SQL) server. - Ability to assess impact cross-functionally, identify costs/benefits to upstream and downstream stakeholders, and solution benefits to multiple business areas. - 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. - High attention to detail and organizational skills. - History of partnering with various levels of leadership across complex organizations, and ability to work cross-collaboratively in a highly matrixed organization. - Strong 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: - Experience leading in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs. - History of excelling in roles impacting quality. - Advanced 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 Azure Databricks and SQL mastery. - Project Management Professional (PMP). - Six Sigma Green Belt or Black Belt certification, and/or comparable coursework. Originally posted on Himalayas
- QA-Manager
- Healthcare-Quality-Manager
- Quality-Director
- Risk-Adjustment-Manager
- HEDIS-Specialist
- Quality-Risk-Management-Manager
- NCQA-Program-Manager
- Quality-And-Compliance-Manager
- Quality-Compliance-Manager
Наблюдалась 2026-10-03, впервые 2026-10-03, источник — Himalayas (JSON API).