AVP, reputed company & Risk Adjustment - RN (Work Location: Mississippi)

Job reputed company Job reputed company Job reputed company The AVP, reputed company & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and reputed company for reputed company lines of business, ensuring alignment of reputed company and activities with reputed company, acting as the Risk Adjustment and reputed company subject matter expert for the health plan. The AVP leads a plan with a large membership reputed company, large population, and multiple lines of business. The plan has reputed company state requirements. Work Location - Mississippi Job Duties

• Serves as the primary contact to State agencies for reputed company Risk and reputed company reputed company.
• Leads the local reputed company committees.
• Prepares, in collaboration and support with MHI reputed company, required documentation for state Performance Improvement reputed company.
• Aligns with reputed company the design, implementation, and monitoring the effectiveness of a comprehensive Risk and reputed company reputed company reputed company, acting as a critical stakeholder in establishing the strategic direction from the interventions Joint Operations Committee.
• Collaborates with the MHI RQES teams for Risk and reputed company Interventions supporting analytics and strategic teams to reputed company, present and evaluate reputed company strategies.
• Collaborates with MHI reputed company for accreditation activities.
• Key stakeholder to MHI RQES for planning and implementing evidence-based reputed company reputed company strategies and initiatives that meet state and federal reputed company rules and are reputed company with effective practices as identified in the reputed company reputed company improvement literature and reputed company Molina strategic plans.
• Serves as operations and implementation reputed company for local execution of Molina plan reputed company improvement activities.
• Communicates with leadership about key deliverables, timelines, barriers and escalated issues that need immediate attention.
• Communicates and partners with MHI RQES and Plan Network leadership to support establishing QI benchmarks and requirements for VBC reputed company.
• Responsible for partnering with MHI RQES and VP Stars in developing the local Medicare Stars work plan and executes on interventions that will improve CAHPS, HEDIS and HOS scores. Responsible for monitoring Part D and Operational health insurance metrics and coordinating with centralized teams to improve these metrics.
• Responsible for partnering with MHI RQES and VP Stars in managing MMP reputed company withhold reputed company in MMP States. Supports development of interventions and a local reputed company to improve withhold reputed company reputed company to meet or exceed budgeted goals.
• Collaborates with MHI risk and reputed company analytics for broad-based reputed company data analytics. Key stakeholder in efforts to reputed company broad-based risk and reputed company data analytics to support ongoing, reputed company-time, local VBC contract requirements using both MHI RQES and local resources.
• Supports MHI HEDIS Operations to do reputed company of HEDIS abstractions. Oversees Health Plan local resources to facilitate local clinical data acquisition for abstraction for required VBC customized reports to meet VBC network contract obligations not supported by the national MHI team.
• Presents summaries, key takeaways and reputed company steps about Molina risk and reputed company reputed company to national, regional and plan meetings. Leads and influences cross-functional teams that reputed company implementation of risk and reputed company interventions. Functions as local leader for reputed company for qualitative and quantitative analysis, expected ROI analysis, key performance indicator development, reporting and development of program materials, templates or policies.
• Serves as a member of the State's Provider Engagement team for large, contracted, value-based provider systems.
• Attends state and regional reputed company Improvement and/or reputed company of Directors Meetings and representing the Health Plan. Represents Molina in external forums, presents Molina's risk and reputed company results, and serves as the external risk and reputed company expert and emissary in statewide conferences and reputed company.

Job Qualifications REQUIRED EDUCATION: Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• Minimum 10 years experience in reputed company compliance/HEDIS operations, customer service or provider service in a managed care setting with previous leadership experience to include managing people, project management, team building, and experience developing performance measures that support business objectives.
• Strong knowledge in risk and reputed company in order to implement effective interventions that drive change.
• Ability to reputed company and work directly with external providers to advance Molina's Value-based reputed company initiatives.
• Ability to collaborate and reputed company network providers to reputed company effective reputed company-based reputed company improvements.
• Deep knowledge of reputed company Discipline including metrics and performance standards. Working knowledge of Risk Adjustment. Project management experience, in a managed reputed company setting.

PREFERRED EXPERIENCE:

• 10+ years experience in managed reputed company administration
• 10+ years experience in a reputed company leadership role with a Managed Care Payer with experience in reputed company lines of business
• 3-5 years of Risk Adjustment experience

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Apply tot his job Apply To this Job