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Molina Healthcare Manager, Healthcare Analytics - Risk Adjustment (Remote) in United States

Job Summary

Collects, validates, analyzes, and organizes data for Risk Adjustment analytics requests and SQL model development to support management decision making for Medicare, Marketplace (ACA), and Medicaid lines of business.

Manages and provides direct oversight of Risk Adjustment Analytics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, maintains internal work plans as well as project work plans to meet reporting needs. Expected to be a working manager in addition to managing a small team.


  • Daily management of analytics projects and models in the Risk Adjustment Analytics Team.

  • Coordinates with Risk Adjustment Operations to meet data analysis needs.

  • Coordinates with Actuary SMEs and IT on SQL risk score model development and maintenance

  • Resource to staff for mentoring, coaching, and analysis questions

  • Analyzes data and processes to determine value and find value opportunities

  • Reviews analyst work products to ensure accuracy and clarity.

  • Reviews regulatory reporting requirements and project documentation.

  • Represents Risk Adjustment Analytics in cross-departmental and operational meetings.

  • Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns and medical management.

  • Interfaces and maintains positive interactions with Health Plan and Corporate personnel.

    Job Qualifications

    Required Education

    Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems or related field

    Required Experience

  • 3 years management or team leadership experience

  • 10 years work experience preferable in claims processing environment and/or healthcare environment

  • Strong knowledge of SQL development in a SQL Server environment

  • Familiar with relational database concepts, and SDLC concepts

    Preferred Education

    Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems or related field.

    Preferred Experience

    3 – 5 years supervisory experience, Risk Adjustment experience

    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.