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Job Description

Job Summary

The Director, Clinical Data Acquisition for Risk Adjustment, is responsible for the implementation, monitoring, and oversight of all chart collection for Risk Adjustment, RADV, or Risk Adjustment-like projects, and other state specific audit projects and deliverables related to accurate billing and coding. This role also works with the Health Plan Risk/Quality leaders to strategically plan for supplemental data source (SDS) acquisition from providers as well as Electronic Medical Record (EMR) access. This position oversees management of training for all CDA team members as well as company Risk Adjustment retrieval and data completeness training, onboarding for CDA team members, vendor management for chart collection vendors, Supplemental data, and chart collection research.

Job Duties

+ Plans and/or implements operational processes for Risk Adjustment operations that meet state and federal reporting requirements/rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina plans.

+ Develops and implements targeted collection of clinical data acquisition related to performance reporting and improvement, including member and provider outreach.

+ Serves as operations subject matter expert and lead for Molina Risk Adjustment, using a defined roadmap, timeline and key performance indicators.

+ Collaborates with the national intervention collaborative analytics and strategic teams to deliver value for both prospective and retrospective risk programs.

+ Communicates with the Molina Plan Senior Leadership Team, including the Plan President, Chief Medical Officer, national Risk Adjustment teams and strategic teams about key deliverables, timelines, barriers and escalated issues that need immediate attention.

+ Presents concise summaries, key takeaways and action steps about Molina Risk Adjustment processes, strategy and progress to national, regional and plan meetings.

+ Demonstrates ability to lead and influence cross-functional teams that oversee implementation of Risk Adjustment projects.

+ Possesses a strong knowledge in Risk Adjustment and RADV to implement effective operations that drive change.

+ Functions as key lead for clinical chart review/abstraction and team management. This includes qualitative analysis, reporting and development of program materials, templates or policies. Maintains productivity reporting, management and coaching.

+ Maintains advanced ability to collaborate and Manage production vendor relationships, including oversight, data driven KPI measurement and performance mitigation strategies.

Job Qualifications

REQUIRED EDUCATION:

Bachelor's Degree in a clinical field, Public Health, Healthcare, or equivalent.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 8+ years’ experience in managed healthcare, including at least 4 years in health plan Risk Adjustment or clinical data acquisition/chart retrieval roles

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

PREFERRED EXPERIENCE:

• 10+ years’ experience with member/ provider (Risk Adjustment) outreach and/or clinical intervention or improvement studies (development, implementation, evaluation)

• 3-5 years Supervisory experience.

• Project management and team building experience.

• Experience developing 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 Risk Adjustment Coder (CRC)

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.

Pay Range: $107,028 - $250,446 / ANNUAL

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