Dir, Medicare Segment Optimization

2 weeks ago

Long Beach, United States Molina Healthcare Full time
Job Description

Job Description

Job Summary

Molina Segment leaders are responsible for the development and administration of Segment specific departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulatory requirements.

Job Duties
  • Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and compliant execution of Medicare performance objectives.
  • Coordinates accountabilities between segment and markets to drive performance in network, risk adjustment, and stars; single point of contact for escalations from aligned market segments.
  • Coordinates accountabilities between segment, health plans, and shared services to drive compliance and performance objectives as well as provide oversight, including service level agreements.
  • Works with staff and senior management to mitigate risk and develop/implement improvements across areas that impact Medicare performance.
  • Collaborates across Medicare segment, with health plans, and enterprise shared services to ensure appropriate performance objectives are met; develop leading indicators and alerts for all key operational metrics.
  • Analyzes activities and identifies trends and potential opportunities within Medicare segment to achieve performance objectives at a state and overall level. .
  • Develop ownership and outcome recommendation for processes that cross functions - segment, enterprise operations, etc.
  • Direct implementation, monitoring, and measurement of strategic and tactical plans that contribute to segment and health plan growth and achievement of other performance objectives.
  • Other operational duties as assigned by the Segment Lead.
Job Qualifications

REQUIRED EDUCATION:

Bachelor's Degree in Business, Health Services Administration or related field, or comparable experience.

REQUIRED EXPERIENCE:
  • 5-10 years' experience in Managed Care, specifically government programs and/or Medicare/Duals Health Plan Operations
  • Strong leadership in a matrixed environment
  • Demonstrated adaptability and flexibility to a rapidly moving business environment.
  • ADDITIONAL SKILLS / TECHNICAL SKILLS:
  • Background analyzing technical performance and driving teams to improvement via direct management and oversight
  • Strong proficiency in MS Office Tools, particularly PowerPoint and Excel.

PREFERRED EDUCATION:

Graduate Degree

PREFERRED EXPERIENCE:

Experience with SNP and MMP Plans

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.

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