Job description

Job Summary

Work Location - Remote within the United States

The Assistant Vice President (AVP) of Risk Adjustment Operations plays a critical role in the development and implementation of business strategies, operations and vendor management related to activities in all government lines of business impacted by regulatory risk adjustment payment models.
Accountable for designing and implementing a strategy that leads to the overall achievement of improved accuracy, compliancy and completeness in risk adjustment revenue for all government lines of business to better support overall population heath management, reduce gaps in care and drive medical loss ratio (MLR) targets.
In conjunction with the VP, Risk Adjustment, this role supports the strategic direction and organization of corporate initiatives to facilitate achievement of the financial strategy and business objectives.

This leadership role interacts and supports regulatory agency policy and procedures by acting as a key business partner to the Vice President of Risk Adjustment, Market & Segment Leaders, health plan product design, and actuary and finance. Direct reports to the AVP include Directors of Prospective Risk Adjustment, Retrospective Risk Adjustment, and Risk Adjustment Success.
The AVP will be working within a highly matrixed organization focused on driving continuous improvements in the described areas.

Knowledge/Skills/Abilities
Collaborates with colleagues to develop/implement strategy, operations and managing vendor alignment for applicable risk adjustment requirements

Manages vendor relationships, deliverables and SLA’s.

Oversees and drives risk assessment and revenue optimization, growth and persistency through strategic collaboration with VP

Serves as strategic leader accountable for implementing, utilizing and/or supporting improved analytics coupled with clinical data and technology to maximize growth, drive continuous improvement in risk adjustment & population health management with applicable matrixed partners

Supports physician education/engagement in risk adjustment models to better align with clinical documentation requirements, value-based payment programs and/or provider performance programs

Engages in technological advances and ensures best in class analytic and reporting capabilities to identify trends driving healthcare outcomes, reducing cost of care and developing/executing risk adjustment programs that are fundamental in timely, accurate & compliant assessments

Develops and sustains a high-performance team, dedicated to best in class solutions, responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.

Ensures performance targets are set, clearly communicated, implemented, assessed and completed for overall team performance and adherence.

Lead, motivate, coach, support and guide direct staff members

Job Qualifications

Required Education

• Minimum Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience

Required Experience

• 10+ years managed care experience, with 7+ years with leadership-level experience preferably with a national or multi-location organization
• Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliancy
• Possess a proven track record of leading & developing high performance teams, with developing strategies for new product/service offerings, provider engagement and value-based initiatives and/or population management engagement
• Excellent leadership skills including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results
• Proven ability to innovate and drive large organizational change
• Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships
• Excellent presentation and communication skills

Preferred Education
Graduate Degree preferred

Pay Range: $140,795 - $274,550 a year*

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

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.

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