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Job Description

Job Summary

Job Summary

The AVP, Clinical Data Acquisition is a key Risk Adjustment (QI) leader within the organization enterprise wide. This position advises senior management, other corporate departments, and Molina health plans on Risk Adjustment/RADV data collection strategies/initiatives and performs oversight over critical Risk related functions. These functions include, but may not be limited to: chart retrieval strategy, risk adjustment retrieval performance, process effectiveness, market performance, project build, chart retrieval maximization and risk adjustment compliance.

Molina Risk Adjustment, Clinical Data Acquisition Team, oversees, plans, and implements new and existing risk adjustment related retrieval/targeting and education programs; ensures accurate and timely collection of medical records and data related to Risk projects; conducts data collection, reporting/monitoring for key performance measurement activities; and provides direction/training/implementation of CMS & State related risk adjustment projects for all lines of business (Medicare, Medicaid and Marketplace)

Knowledge/Skills/Abilities

• Collaborates with senior executives, Vice Presidents and others across Molina Healthcare to set and achieve Risk Adjustment goals.

• Develops training, goals and coaching plans for Risk Adjustment and local field staff.

• Ensures that quality assurance is performed for all reports generated by staff.

• Escalates gaps and barriers in implementation and compliance to VP and other corporate senior management as appropriate.

• Serves as a subject matter expert and represents the Clinical Data Acquisition department in meetings and discussions about functional area.

• Collaborates and facilitates activities with other units at corporate and Molina Plans.

• Identifies and implements new Risk Adjustment related projects/requirements

• Responsible for audits for risk adjustment and project set-up/implementation

• Manages state Risk/Quality leader relationships and RA related collection strategies

• Supports Key Metrics with standardized reporting for chart performance and financial impacts.

• Develops/maintain project plans, with in-depth operational tracking. Manages staff and teams using productivity tools.

• Works with IT to develop/operate and maintain reliable processes around key operational reporting.

Job Qualifications

Required Education

Bachelor's Degree in a clinical field, IT, Public Health or Healthcare Administration or equivalent combination of education and work experience.

Required Experience

• Minimum 10 years relevant experience, including at least 5 years in health plan risk adjustment.

• Minimum 4 years Medicaid/ Medicare/Marketplace experience.

• Minimum 5 years people management experience

• Minimum 5 years Risk adjustment audit/RADV experience

• Demonstrated knowledge of and experience with chart retrieval programs for risk adjustment.

• Technical experience in reporting and/or programming.

• Proficiency with Excel and Visio (flow chart equivalent) and demonstrated ability to learn new information systems and software programs.

• Must have a deep understanding of the Claims, Encounters, Pharmacy, Enrollment, Supplemental data etc. processes to assure data validation, audit and management.

Preferred Education

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

Preferred Experience

• RADV and Risk Adjustment improvement experience

• State related risk adjustment experience

• 3+ years experience in Reporting & Analytics for chart retrieval and/or Risk Adjustment

• 3+ years health care information systems experience

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Nursing License

• Certified Risk Adjustment Coding (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: $140,795 - $274,550.26 / ANNUAL

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