Remote Risk Adjustment Coding Jobs in California

JOB DESCRIPTION Job Summary
Leads and manages team responsible for health plan provider engagement activities. Collaborates with senior leadership and the health plan network team to drive value-based care strategies, and operational direction for risk adjustment and quality improvement. Sets and manages performance goals, ensuring providers meet quality and risk adjustment targets through coaching and consistent engagement. Tracks and measures the effectiveness of engagement activities - driving provider participation in Molina's risk adjustment and quality initiatives.
Essential Job Duties
• Manages team of provider engagement professionals responsible for enhancing value-based strategies and risk adjustment/quality improvement initiatives, and reducing medical cost ratio (MCR).
• In collaboration with senior quality/network leadership, establishes strategy and operational initiatives for engaging providers on risk adjustment and quality improvement.
• Sets health plan level performance goals, and manages progress for key performance indicators.
• Ensures each tier I, tier II and tier III provider has quality and risk adjustment performance goals and execution plans to meet committed goals, with emphasis on tier I and tier II.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals, and recommends and implements solutions required to improve health outcomes.
• Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g., supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
• Demonstrates provider engagement subject matter expertise; works collaboratively across the health plan and Molina's centers of excellence and shared services to drive improved risk adjustment and quality of care.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and provider engagement activities.
• Assesses provider engagement team members across required competency matrix and ensures they receive needed training on any lagging competencies.
• Ensures provider engagement team uses standard Molina provider engagement reports and training materials.
• Develops, organizes, analyzes, documents, and implements processes and procedures as prescribed by the health plan and corporate policies.
• Communicates effectively with internal and external stakeholders, including providers.
• Maintains the highest level of compliance.
• Hires, trains, mentors, and develops quality team; demonstrates accountability for team performance and delivery/accountability to established targets/goals.
• Provides support for quality-related initiatives, projects, and process improvement opportunities.
• May require same day out-of-office travel up to 30% of the time, depending upon state/health plan requirements.
Required Qualifications
• At least 7 years of experience improving provider quality performance through provider engagement, practice transformation, and/or managed care quality improvement initiatives, or equivalent combination of relevant education and experience.
• At least 1 year management/leadership experience.
• Experience with various managed health care provider compensation methodologies including but not limited to: fee-for service (FFS), value-based care (VBC), and capitation.
• Strong working knowledge of quality metrics and risk adjustment practices across all business lines.
• Advanced knowledge and understanding of HEDIS/NCQA.
• Strong relationship building skills.
• Strong proficiency with data analysis, manipulation, interpretation and reporting.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Project management experience.
• Strong verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.
Preferred Qualifications
• Experience improving quality performance for Medicaid, Medicare, and/or Marketplace programs.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V