Remote Risk Adjustment Manager Jobs (NOW HIRING)

JOB DESCRIPTION Job Summary
Provides lead level analyst support for Molina enterprise risk adjustment predictive analytics activities. Designs and develops suspect, targeting, and tracking system to support Molina's prospective and retrospective interventions.
Essential Job Duties
• Assists risk adjustment data analytics leaders in prospective and retrospective intervention strategy analytics, and corresponding tracking of progress and impact of interventions.
• Designs and leads development of tracking system for risk scores for all intervention outcome and for overall markets and lines of business.
• Develops quality assurance (QA) ad-hoc and automated reporting modules related to risk adjustment for Medicaid, Marketplace and Medicare/Medicare-Medicaid Plan (MMP) lines of business.
• Assists risk adjustment data analytics leaders in developing automated suspect and target/ranking engine for all lines of businesses.
• Facilitates analysis and reporting related to managed care data including claims, pharmacy, lab and related financial data (risk score/revenue/cost).
• Calculates and tracks risk scores for all intervention outcomes for all markets/lines of business.
• Works in an agile business environment; derives meaningful information out of complex/large organizational data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
• Collaborates with interdepartmental stakeholders and leaders to establish/deliver/explain the business requirement and data/data points, and facilitates escalation as needed.
• Conducts root-cause analysis for business data issues.
• Analyzes data sets and trends for anomalies, outliers, trend changes and opportunities using statistical tools and techniques to determine significance and relevance; utilizes extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance; provides executive summary of findings to requestors.
• Assists 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.
• Adheres to Centers for Medicare and Medicaid Services (CMS)/state regulations related to risk adjustment analytics, and provides training as required.
• Stays current with industry regulation changes related to risk adjustment, and educates teams/leaders as necessary.
• Tracks, facilitates and manages changes in the Datawarehouse platform and performs transparent upgrades to analytics reporting modules to ensure no impact to end users.
• Conducts preliminary and post-impact analyses for any logic and source code changes for data analytics and reporting module, keeping other variables as constant that are not of focus.
• Develops training modules to help analysts understand processes, solutions or designs to meet the customer request.
• Maintains a team culture to adopt fast-paced agile environment and foster a positive attitude to take on challenging and time sensitive projects.
• Provides support for risk-adjustment related special projects.
• Provides training to new and existing risk adjustment predictive analytics team members.
Required Qualifications
• At least 4 years of experience writing complex SQL queries, functions, procedures, and data design, including experience working with relational databases, Microsoft Transact-SQL (T-SQL), SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), and Power BI, and predictive modeling experience in health care quality and HEDIS rate tracking, medical record review tracking, interventions tracking, and statistical analysis/HEDIS forecasting experience supporting quality, finance, and health plan functions, or equivalent combination of relevant education and experience.
• Analytical mindset, excellent attention to detail, and problem-solving skills.
• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• Experience working with Microsoft T-SQL, Databricks SQL and Power BI.
• Experience writing complex SQL queries, functions, procedures and data design.
• Experience with Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Strong business acumen with the ability to connect data insights to strategic goals.
• Ability to communicate complex analytical results clearly to non-technical audiences.
• Proven ability to lead cross-functional projects and deliver value added results in a highly matrixed environment.
• Self-starter with a continuous improvement mindset.
• Effective verbal and written communication skills.
• Microsoft Office suite proficiency.
Preferred Qualifications
• Familiarity with data science techniques and languages like Python and R programming.
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