USACares Jobs

Job Information

Molina Healthcare Regional Manager, Risk Adjustment in Columbus, Ohio

Job Description

Job Summary

The Regional Manager of Risk Adjustment is responsible for managing a team of professionals to meet the needs of the Medicaid, Medicare, and Marketplace lines of business as it relates to risk adjustment.


• Manages risk adjustment staff in Regions (East, West, Central)

• Monitors and tracks progress on risk adjustment initiatives across the region

• Coordinates with Corporate Risk Adjustment to develop work plan and goal alignment within the region

• Ensures standardization across the region related to risk adjustment for all lines of business (Medicaid, Medicare, and Marketplace)

• May establish state specific policies and procedures outside of the enterprise risk adjustment model

• Analyzes regional reports and audit findings to track progress as it relates to goals and KPIs

• Implements coaching and training plans

• Escalate gaps in projects to Director or Senior Leadership

• Responsible for assisting the Director with implementation and oversight of risk adjustment projects

• Management of Medicaid retrospective medical record review processes

Job Qualifications

Required Education

BS Degree in Finance, Healthcare Administration, Business Administration or Health Information Management or equivalent work experience

Required License, Certification, Association

• 3 years' experience working in Risk Adjustment in a healthcare environment

• Proficiency with risk adjustment methodologies

• Understanding of healthcare terminology (CPT, ICD-10)

• Knowledge of coding, HCCs, risk adjustments concepts, medical record review project management, encounter data management, compliance audit concepts

• Strong familiarity and experience with underserved populations

Preferred Experience

• 3 - 5 years management experience

• Experience with risk adjustment data validations or equivalent compliance audits

• Prior experience with CMS risk adjustment projects preferred.

Preferred License, Certification, Association


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.