Risk Adjustment Coord (4062BR) Long Beach, California

Job Summary

Responsible for implementing and monitoring local risk adjustment coordination efforts.

Essential Functions

• Defines and implements HP risk adjustment strategy in conjunction with Corporate Risk Adjustment department and plan QI and Provider Services Directors
• Works with Manager, Coding and Education and Manager, Vendor Oversight and CMS Submission to implement appropriate chart reviews and in-home assessments
• Removes barriers to access to provider records and / or barriers to contacting members
• Works with HP and Corp Reporting to monitor completed provider and member assessments to ensure Corporate goals are achieved within that HP
• Escalates problems promptly that would prevent Corporate goals from being achieved and recognizes the financial and compliance risk of not doing so

Knowledge/Skills/Abilities

Quality Family 
• Business Acumen (entry level) -  Knows how businesses work; knowledgeable in current and possible future policies, practices, trends, technology, and information affecting his/her business and organization; knows the competition; is aware of how strategies and tactics work in the marketplace.
• Creativity (developing) -  Comes up with a lot of new and unique ideas; easily makes connections among previously unrelated notions; tends to be seen as original and value-added in brainstorming settings.
• Customer Focus (developing) - Is dedicated to meeting the expectations and requirements of internal and external customers; gets first-hand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect.
• Decision Quality (developing) -  Makes good decisions (without considering how much time it takes) based upon a mixture of analysis, wisdom, experience, and judgment; most of his/her solutions and suggestions turn out to be correct and accurate when judged over time; sought out by others for advice and solutions.
• Informing (proficient) -  Provides the information people need to know to do their jobs and to feel good about being a member of the team, unit, and/or the organization; provides individuals information so that they can make accurate decisions; is timely with information.
• Integrity & Trust (proficient) -  Is widely trusted; is seen as a direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn't misrepresent him/herself for personal gain.
• Managerial Courage (developing) -  Doesn't hold back anything that needs to be said; provides current, direct, complete, and "actionable" positive and corrective feedback to others; lets people know where they stand; faces up to people problems on any person or situation (not including direct reports) quickly and directly; is not afraid to take negative action when necessary.
• Negotiating (proficient) -  Can negotiate skillfully in tough situations with both internal and external groups; can settle differences with minimum noise; can win concessions without damaging relationships; can be both direct and forceful as well as diplomatic; gains trust quickly of other parties to the negotiations; has a good sense of timing.
• Perseverance (developing) -  Pursues everything with energy, drive, and a need to finish; seldom gives up before finishing, especially in the face of resistance or setbacks.
• Problem Solving (developing) -  Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn't stop at the first answers.
• Drive for Results (developing) -  Can be counted on to exceed goals successfully; is constantly and consistently one of the top performers; very bottom-line oriented; steadfastly pushes self and others for results.
• Self-Development (proficient) -  Is personally committed to and actively works to continuously improve him/herself; understands that different situations and levels may call for different skills and approaches; works to deploy strengths; works on compensating for weakness and limits.
• Time Management (developing) -  Uses his/her time effectively and efficiently; values time; concentrates his/her efforts on the more important priorities; gets more done in less time than others; can attend to a broader range of activities.



Required Education:
Bachelor's degree or equivalent work experience

Required Experience:
• Minimum of 1 year experience in health plan quality improvement or equivalent experience

Required Licensure/Certification/Associations:
Registered Nurse
Preferred Education:
Preferred field: clinical, public health or healthcare

Preferred Experience:
Medicare Coding

Preferred Licensure/Certification/Associations:
Some clinical training (i.e. LVN, EMT, LCSW, Medical Assistant). CPC Coding Certification



To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

To apply, please click here