National Quality Performance Manager
$59.8k - $129.6k/yr
Mid
Remote in USA
Remote
Project & Program ManagementProgram Management
About the job
Requirements
- At least 3 years of program or project management experience in quality, or an equivalent combination of relevant education and experience.
- Health care experience or demonstrated functional quality knowledge.
- Intellectual agility and the 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.
- Attention to detail and organizational skills.
- Ability to work cross-collaboratively in a highly matrixed organization.
- Effective verbal, written, and presentation communication skills.
- Proficiency with the Microsoft Office suite, including Excel, and applicable software programs, and ability to learn and navigate new software programs.
Responsibilities
- Collaborate with health plan quality leaders to improve outcomes by managing quality data collection strategy, analytics, and reporting for quality rate trending and forecasting, provider quality measurement performance, CAHPS and survey analytics, health equity and social determinants of health, and external vendor engagement.
- Monitor quality-related projects from inception through successful delivery.
- Oversee quality data ingestion activities through data validation, issue identification, and documentation to improve completeness and accuracy of electronic health record and health information exchange data and supplemental data impact.
- Analyze quality data and identify potential performance improvement opportunities.
- Ensure compliance with quality-related regulatory audit guidelines by adhering to deliverable roadmaps and timelines, and implement solutions to maximize national HEDIS audit success.
- Partner with cross-functional teams to ensure data quality delivery through sequential transformations and identify opportunities to close quality care gaps.
- Create, review, and update quality-related program documentation, including plans, reports, and records, and ensure information is accessible for quality teams throughout the enterprise.
- Proactively communicate regular quality-related status reports to stakeholders, highlighting progress, risks, and issues.
- Meet customer expectations and requirements, establish and maintain effective relationships, and gain trust and respect.
Desired Qualifications
- Familiarity with running queries in Microsoft Azure or SQL Server.
- Intermediate knowledge or experience related to NCQA, HEDIS, CMS, and state-specific regulatory submission requirements.
- Knowledge of health care claim elements, including CPT, CPT Category II, LOINC, SNOMED, HCPS, NDC, CVX codes, NPIs, and TINs.
- Experience working in a cross-functional, highly matrixed organization, preferably within a managed care organization supporting Medicaid, Medicare, or Marketplace programs.
- Project Management Professional certification.
- Six Sigma Green Belt or Black Belt certification, or comparable coursework.
About the company
Molina Healthcare runs health insurance plans for people covered by Medicaid, Medicare and state insurance marketplaces, with a focus on people who need affordable access to care. Its local health plans coordinate medical services and support members with complex health needs, including people eligible for both Medicaid and Medicare. Members receive care through networks of doctors, hospitals and other providers, while the plans manage benefits, process claims and arrange care support. The company earns premiums from government programs and members, and pays the cost of covered healthcare services. Molina was founded in 1980 and is headquartered in Long Beach, California.
Company Size
10,001+
Company Stage
IPO
Headquarters
Long Beach, California
Founded
1980
Get referred to Molina Healthcare
See people who can refer or advise you
Simplify's Take
What believers are saying
- Illinois continuity gained ground: June 2026 brought an intended Molina Medicaid contract award for four-and-a-half years.
- Recovery has a higher target: Molina raised adjusted earnings guidance to $5.25 per share in July 2026.
- Career development has a named route: Molina's Pathways to Success helps staff navigate careers across the organization.
What critics are saying
- Profits remain under pressure: Molina reported a 76% quarterly net income decline in July 2026.
- Margins are fragile: Molina estimates one additional medical spending percentage point cuts 2025 earnings per share by $6.20.
- Remote still means travel: Molina's California site review nurse role requires field visits three to four days weekly.
What makes Molina Healthcare unique
- Pharmacy work goes outside: Molina outsources drug benefits administration to CVS Caremark.
- Wisconsin work includes long-term care: Molina's My Choice Wisconsin runs Family Care and Partnership programs.
- Connecticut retains a local brand: Molina owns ConnectiCare, a health plan focused on the state.
Help us improve and share your feedback! Did you find this helpful?
Benefits
- Health Insurance
- 401(k) Retirement Plan
- Remote Work Options
- Paid Vacation
- Flexible Work Hours
- Wellness Program
- Mental Health Support
- Conference Attendance Budget
- Professional Development Budget
- Phone/Internet Stipend
- Home Office Stipend
- Family Planning Benefits