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JOB DESCRIPTION

JOB SUMMARY:

The Analyst, Risk and Quality Reporting role supports Molina’s Risk and Quality Health Plan team. This position designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of the initiatives. Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.

ESSENTIAL JOB DUTIES:

+ Work with assigned health plan to capture and document requirements, build custom health plan reports, and educate health plan users on how to use reports

+ Build intervention strategy reporting for the Risk and Quality interventions and measure gap closure.

+ Build ad hoc reports as requested to track HEDIS performance and supplemental data monitoring

+ Development and QA of custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP

+ Develop custom health plan reports related to managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates

+ Assists and collaborates with the national Risk and Quality department with testing of pre-production reporting for the assigned health plan

+ Calculate and track gap closure and intervention outcome reporting for the assigned state

+ Work in an agile business environment to derive meaningful information out of organizational data sets through data analysis and data profiling

+ Analyze data sets and trends for anomalies, outliers, trend changes, and opportunities, using databricks SQL, PowerBi, excel, and techniques to determine significance and relevance

+ Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations

REQUIRED QUALIFICATIONS:

+ Bachelor's Degree or equivalent combination of education and work experience

+ 1-3 years of experience in working with data mapping, data profiling, scrapping, and cleaning of data.

+ 1-3 years of experience in a Managed Care Organization executing similar techno functional role that involves writing SQL Queries, Functions, Procedures, and Data design

+ 1-3 years of experience working with Microsoft T-SQL, Databricks SQL and PowerBI

+ Familiarity with Microsoft Azure, AWS or Hadoop

+ 1-3 years of experience in Analysis related to health care reporting

+ 1-3 years of experience in working with data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics

+ Familiarity with HEDIS and Risk data

Preferred Education

Master's Degree or higher in a clinical field, Public Health or Healthcare

Preferred Experience

+ 1 year of experience in Medicare and in Medicaid

+ HEDIS reporting or collection experience

+ Experience developing and / or analyzing performance measures that support business objectives

+ Preferred License, Certification, Association

+ Certified Professional in Health Quality (CPHQ)

+ Nursing License (RN may be preferred for specific roles)

+ Certified HEDIS Compliance Auditor (CHCA)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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Pay Range: $68,640 - $111,967 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.