About the position
Responsibilities
• Manage project and/or program managers within the Risk and Quality Systems team to ensure alignment with RQS strategies and goals.
• Support annual quality data submissions including NCQA and state regulatory submissions.
• Design and develop data-focused strategies to improve data ingestion activities.
• Collaborate with Risk & Quality leaders to enhance program performance through meaningful reporting and analytics.
• Develop and maintain comprehensive project plans, ensuring timely and high-quality deliverables.
• Identify potential risks and develop mitigation strategies for project plans.
• Resolve complex problems through project management and stakeholder collaboration.
• Conduct regular reviews and audits to maintain performance standards.
• Address issues or discrepancies promptly to ensure program success.
• Develop data quality strategies to close risk and quality care gaps.
• Communicate effectively with stakeholders, reporting risks and issues with recommended solutions.
• Prepare and present regular status reports to stakeholders, highlighting progress and risks.
• Foster a collaborative and high-performing team environment.
• Promote professional development and knowledge sharing within the team.
• Mentor team members to develop their professional expertise.
Requirements
• Bachelor's degree or equivalent combination of education and experience.
• 8+ years of program and/or project management experience in risk adjustment and/or quality.
• 4-6 years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems.
• 4-6 years of data analysis experience utilizing technical skillsets to answer risk and quality questions.
• People management experience demonstrating excellent leadership skills.
• Expertise with running queries in Microsoft Azure or SQL server.
• Mastery of Microsoft Office Suite including Excel and Project.
• Significant healthcare experience with excellent risk adjustment and/or quality knowledge.
• History of partnering with various levels of leadership across complex organizations.
• Comprehensive mastery of the drivers of value in managed health care and in-depth knowledge of the healthcare industry.
• Expert-level ability to think cross-functionally and identify cost/benefits to stakeholders.
• Strong quantitative aptitude and problem-solving skills.
• Intellectual agility and ability to simplify complex concepts.
• Excellent verbal, written, and presentation capabilities.
• Energetic and collaborative personality.
• Extensive knowledge of healthcare claim elements.
Nice-to-haves
• Graduate degree or equivalent combination of education and experience.
• Experience in a leadership role within a cross-functional, highly matrixed organization.
• SQL mastery.
• History of excelling in roles impacting both risk adjustment and quality.
• PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, or comparable coursework.
Benefits
• Competitive benefits and compensation package.
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