Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Director, Quality & Risk Adjustment
Location
United States
Posted
16 days ago
Salary
Not specified
No structured requirement data.
Job Description
Role Description
The Director, Quality & Risk Adjustment is responsible for leading health plan execution for Risk and Quality ensuring alignment of strategy and activities with Enterprise and acting as the Risk and Quality subject matter expert for the health plan.
- Primary interface with state agencies
- Leadership of local Quality committees
- Oversight and execution of local intervention activities intended to improve quality measures and outcomes
- Collaborates with MHI Quality leaders to conduct data collection, reporting and monitoring for key Quality performance measurement activities
- Coordinates with MHI Quality leaders on the implementation of NCQA accreditation surveys and federal QI compliance activities
- Responsible for local execution supporting Medicare Stars strategies and performance improvement
Qualifications
- Bachelor's Degree in a related field (Healthcare Administration, Public Health, or equivalent experience)
- Minimum 8 years experience in quality compliance/HEDIS operations, customer service or provider service in a managed care setting
- Previous leadership experience including managing people, project management, and team building
- Experience developing performance measures that support business objectives
- Strong knowledge in risk and quality to implement effective interventions that drive change
- Ability to inspire and work directly with external providers to advance Molina’s Value-based quality initiatives
- Ability to collaborate and educate network providers to develop effective practice-based quality improvements
- Deep knowledge of Quality Discipline including metrics and performance standards
- Working knowledge of Risk Adjustment
- Project management experience in a managed healthcare setting
Requirements
- 8+ years experience in managed healthcare administration
- 8+ years experience in Quality leadership role with a Managed Care Payer with experience in all lines of business
- 3-5 years of Risk Adjustment experience
Benefits
Molina Healthcare offers a competitive benefits and compensation package.
Company Description
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Requirements
- Bachelor's Degree in a related field (Healthcare Administration, Public Health, or equivalent experience)
- Minimum 8 years experience in quality compliance/HEDIS operations, customer service or provider service in a managed care setting
- Previous leadership experience including managing people, project management, and team building
- Experience developing performance measures that support business objectives
- Strong knowledge in risk and quality to implement effective interventions that drive change
- Ability to inspire and work directly with external providers to advance Molina’s Value-based quality initiatives
- Ability to collaborate and educate network providers to develop effective practice-based quality improvements
- Deep knowledge of Quality Discipline including metrics and performance standards
- Working knowledge of Risk Adjustment
- Project management experience in a managed healthcare setting
- 8+ years experience in managed healthcare administration
- 8+ years experience in Quality leadership role with a Managed Care Payer with experience in all lines of business
- 3-5 years of Risk Adjustment experience
Benefits
- Molina Healthcare offers a competitive benefits and compensation package.
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