ColumbusRecruiter Since 2001
the smart solution for Columbus jobs

Regional Manager, Risk Adjustment

Company: Molina Healthcare
Location: Columbus
Posted on: November 22, 2020

Job Description:

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.

Keywords: Molina Healthcare, Columbus , Regional Manager, Risk Adjustment, Executive , Columbus, Ohio

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Executive Jobs

Support Account Manager
Description: Are you data-driven We at NetApp believe in the transformative power of data to expand customer touchpoints, to foster greater innovation, and to optimize operations. We are designed for simplicity, (more...)
Company: NetApp
Location: Columbus
Posted on: 11/26/2020

Physician / Neurology / Ohio / Permanent / Associate Medical Director
Description: Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews (more...)
Company: eviCore healthcare
Location: Columbus
Posted on: 11/26/2020

Account Manager Manufacturing, Troy, Versailles
Description: Company OverviewGrainger is a global leading broad line supplier of facilities maintenance products serving businesses and institutions. Our 25,000 employees are driven to serve customers and the community (more...)
Company: Grainger
Location: Dayton
Posted on: 11/26/2020

Branch Manager - Trainee (Columbus,OH)
Description: Manager in DevelopmentWe are looking for eager and dedicated field managers to run our established branch locations across the United States. We will give you the tools you need to run a business, manage (more...)
Company: Stanley Steemer
Location: Columbus
Posted on: 11/26/2020

Computer Systems Security Manager (Canton,OH)
Description: Are you interested in bringing your talents to the forefront of innovation and excellence Please join us for our Career Talks
Company: National Security Agency
Location: Canton
Posted on: 11/26/2020

Database Manager - Virtual Career Fair (Dayton,OH)
Description: Are you interested in bringing your talents to the forefront of innovation and excellence Please join us for our Career Talks
Company: National Security Agency
Location: Dayton
Posted on: 11/26/2020

Assistant Manager
Description: Assistant ManagerRusty Taco believes in the importance of flexibility for employers and employees alike, and we believe that our employees are our greatest asset. We treat our people with respect and (more...)
Company: Rusty Taco
Location: Dayton
Posted on: 11/26/2020

Manager II, Facilities Management Hvac/R- General ...
Description: Manages heating, ventilation,
Company: Connexus
Location: Dayton
Posted on: 11/26/2020

(HIM 10083) Sr. Configuration Manager - Wright-Patterson AFB (OH with Security Clearance
Description: HIM 10083 Sr. Configuration Manager - Wright-Patterson AFB OH Location : Dayton, OH Clearance Required: Secret PCI has an exciting opportunity for an experienced Configuration Manager to support the (more...)
Company: PCI
Location: Dayton
Posted on: 11/26/2020

Fleet Maintenance Manager
Description: JOB DESCRIPTION br br Job : 34438 Title: Fleet Maintenance Manager Job Location: Columbus, Ohio - United States Employment Type: Salary: contact recruiter for details Other Compensation: NA Employer (more...)
Company: NPAworldwide Recruitment Network
Location: Columbus
Posted on: 11/26/2020

Log In or Create An Account

Get the latest Ohio jobs by following @recnetOH on Twitter!

Columbus RSS job feeds