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As part of Molina’s response to the COVID-19 pandemic, unless otherwise prohibited by law, new hires with a start date of November 1, 2021 or later will be required to be fully vaccinated.

Director, Prospective Programs

Molina Healthcare United States Job ID 2010382
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Job Summary

The Director, Prospective Programs is part of our innovative Risk Adjustment department to assist our diverse team of data leaders, risk adjustment experts, and developers in the development and implementation of business strategies, operations and vendor management related to prospective activities in all government lines of business impacted by the regulatory risk adjustment payment model.

They will be accountable for designing and implementing a prospective program strategy that leads to the overall achievement of improved risk score 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 AVP Risk Adjustment Operations, 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 Risk Adjustment, Market & Segment Leaders, health plan product design, actuary, and finance. Direct reports to the Director include the manager of in-home assessment program, manager of member engagement programs, and manager of provider engagement programs.

The position's essential functions are as follows:

  • Collaborates with colleagues to develop/implement strategy, operations, and support vendor alignment for prospective risk adjustment initiatives
  • Oversees and drives accurate risk adjustment scores through strategic collaboration with AVP, Risk Adjustment Operations
  • Accountable for utilizing and/or supporting improved analytics coupled with clinical data and technology to 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
  • Supports member engagement initiatives to align with clinical documentation requirements
  • Engages in technological advances and ensures best in class 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
  • Maintains compliance with all policies and procedures.
  • Adheres to all confidentiality and HIPAA requirements as outlined within Policies and Procedures in all ways and at all times with respect to any aspect of the data handles or services rendered in the undertaking of the position.
  • Fulfills those responsibilities and/or duties that may be reasonably provided by Molina for the purpose of achieving operational and financial success of the Company.


Required Education

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

Required Experience

  • 5-7 years managed care experience, with 3+ 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
  • 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 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

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

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 09/30/2021


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