Risk Management Director - Healthcare jobs in Long Beach, CA
Risk Management Director - Healthcare develops and administers risk management programs. Creates and modifies policies to comply with safety legislation, JCAHO, HIPAA, and industry practices. Being a Risk Management Director - Healthcare coordinates and develops hospital-wide programs for quality patient care and risk-free services. Acts as the liaison to attorneys, insurance companies, and individuals. Additionally, Risk Management Director - Healthcare investigates any incidences that may result in an asset loss. Oversees insurance designed to protect the health system from loss. Collects information related to the claims and lawsuits made against the health system. May require a bachelor's degree. Typically reports to top management. The Risk Management Director - Healthcare typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Risk Management Director - Healthcare typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added Risk Management Director - Healthcare jobs
Director, Risk Adjustment
- Molina Healthcare
-
Long Beach, CA
FULL_TIME
-
Job Description
Job Summary
Responsible for planning, directing, and administering various high level initiatives related to, but not limited to, the following tasks and responsibilities. Supports portions of the legal function. Reviews, researches, negotiates, and/or prepares contracts, patents, or other documents.
Knowledge/Skills/Abilities
The Director of Risk Adjustment is a key leadership position within the Quality department. The Director is responsible for setting appropriate risk scores for Molina Medicare members and Molina Medicaid members where risk adjustment is permitted. Risk adjustment can be performed using prospective and retrospective methods and the Director is responsible for both. The Director is also responsible for coding and training policy oversight. Lastly, the Director must oversee the mission-critical function of building and monitoring the risk adjustment data validation (RADV) function, whose soundness will significantly mitigate compliance and financial risk to the Molina organization.
The position's essential functions are as follows:
- Sets goals and plan of Risk Adjustment division (with support from VP)
- Manages staff in division
- Sets training and coaching plan for Corporate and health plans on Risk Adjustment concepts and critical success factors
- Plans timelines and resource requirements; works with staff and Analytics to figure out dollars at risk
- Works with HP QI departments to identify correct resources for each project
- Sets retrospective review policies
- Sets prospective review policies
- Sets RADV (proposed CMS audit) policies (emphasize compliance should be considered as well as revenue)
- Sets coding policies and plans long-term plan to use technology and other resources to provide more and better information to network providers
- Develops tracking and monitoring mechanisms for all projects
- Reports status of risk scores on monthly basis to VP
- Serves as SME in meetings
- Escalates gaps in projects to VP and senior management when identified
- Responsible to comply with State Medicaid and CMS regulations with respect to Risk Adjustment rules
Job Qualifications
Required Education
BA / BS / BSN or equivalent work experience
Required Experience
- Minimum of 5 year's experience in health plan encounter and chart data retrieval projects or equivalent
- 2 years Medicare experience
- 2 years Medicaid experience
- Minimum 3 years management experience
Active, unrestricted State Licensed Vocational Nurse in good standing
Preferred Education
Clinical degree or advanced IT degree or advanced public health or health care administration degree
Preferred Experience
- Risk adjustment project experience
- Medical coding experience
- Provider communication experience
- Managing medical record retrieval projects
CPHQ
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. - 22 Days Ago
Customer Service Representative
- Avalon Risk Management
-
Torrance, CA
FULL_TIME
- Avalon Risk Management, a national insurance broker specializing in the international transportation industry, is looking for a full time highly motivated self-starter with an entrepreneurial spirit. ...
- 8 Days Ago
Risk Adjustment Coder
- Advanced Medical Management, Inc.
-
Long Beach, CA
FULL_TIME
- TITLE RISK ADJUSTMENT CODER I POSITION SUMMARY The Risk Adjustment Coding Specialist is responsible for Risk Adjustment HCC coding management and training both internally and externally to ensure that...
- 20 Days Ago
Interim Director of Case Management
- Clinical Management Consultants
-
Torrance, CA
FULL_TIME
- A new Interim opportunity has just become available for an Interim Director of Case Management with a reputable hospital in the beautiful sunshine state of California! This Interim Nurse Director of C...
- 10 Days Ago
Interim Nurse Director Case Management
- Clinical Management Consultants
-
San Pedro, CA
FULL_TIME
- An excellent opportunity is now available for an Interim Nurse Director of Case Management at a large Southern California Medical Center. The Interim Nurse Director of Care Coordination will be respon...
- Just Posted
Nurse Director Hospital Case Management
- Clinical Management Consultants
-
Torrance, CA
FULL_TIME
- We are seeking a highly skilled and experienced Nurse Director of Case Management to join an acute care hospital located in the urban setting of southern Los Angeles County. As part of a national for-...
- 15 Days Ago
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0 Risk Management Director - Healthcare jobs found in Long Beach, CA area
Director of Risk Management and Compliance
- The Whole Child - Mental Health & Housing
-
Whittier, CA
- JOB OVERVIEW The Director of Risk Management & Compliance will be responsible for ensuring The Whole Child (TWC) adheres...
- 4/26/2024 12:00:00 AM
Licensing & Contracts Administrator
- South Central Family Health Center
-
Los Angeles, CA
- Title: Licensing & Contracts Administrator Base Salary Range: $80,000 -$89,000 - plus benefits FTE: Full-Time - Exempt O...
- 4/26/2024 12:00:00 AM
Risk Management & Compliance Director
- HR Pals
-
Whittier, CA
- Job Overview The Director of Risk Management & Compliance will be responsible for ensuring The Whole Child (TWC) adheres...
- 4/26/2024 12:00:00 AM
Human Resources Specialist
- Vallarta Supermarkets
-
Downey, CA
- We are looking for a dynamic Store HR Safety Compliance Specialist to help drive our Vallarta Culture. We offer competit...
- 4/26/2024 12:00:00 AM
Human Resources Specialist
- Vallarta Supermarkets
-
Downey, CA
- We are looking for a dynamic Store HR Safety Compliance Specialist to help drive our Vallarta Culture. We offer competit...
- 4/24/2024 12:00:00 AM
Manager Quality and Risk Management
- Arroyo Vista Family Health Center
-
Los Angeles, CA
- Job Description Job Description Salary Range: $87,500 to $95,000 Annually Summary: Under the direct supervision of the Q...
- 4/24/2024 12:00:00 AM
Risk Consultant
- Bbsi
-
Ontario, CA
- Our focus is business owners. Is yours? Barrett Business Services, Inc. (BBSI) helps business owners focus on their busi...
- 4/23/2024 12:00:00 AM
Risk Consultant
- BBSI
-
Ontario, CA
- Our focus is business owners. Is yours? Barrett Business Services, Inc. (BBSI) helps business owners focus on their busi...
- 4/22/2024 12:00:00 AM
About Long Beach, California
Long Beach is a city on the Pacific Coast of the United States, within the Los Angeles metropolitan area of Southern California. As of 2010, its population was 462,257. It is the 39th most populous city in the United States and the 7th most populous in California. Long Beach is the second-largest city in the Los Angeles metropolitan area and the third largest in Southern California behind Los Angeles and San Diego. Long Beach is a charter city.
The Port of Long Beach is the second busiest container port in the United States and is among the world's largest shipping ports. The city also maintai...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Risk Management Director - Healthcare jobs
$153,637 to $203,605
Long Beach, California area prices
were up 3.2% from a year ago
were up 3.2% from a year ago
What does a Risk Management Director - Healthcare do?
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