Vice President of Member Services

2 weeks ago

Covington, United States Molina Healthcare Full time
Job Overview

Key Responsibilities



• Oversee all aspects of Member and Provider Services, including Workforce Management, Reporting, Data & Analytics, Quality Assurance, Business Solutions, Vendor Performance, and Telephony across Medicaid, Medicare, and Marketplace.

• Spearhead strategic initiatives aimed at operational excellence to foster growth and enhance satisfaction for both members and providers.

• Cultivate and sustain robust relationships with internal and external stakeholders to ensure optimal shared services across the organization.

• Facilitate the seamless integration of newly acquired personnel, defining scope of work and organizational structure.

• Identify and implement projects/initiatives that lower administrative costs while introducing innovative solutions. Assemble work groups, develop implementation plans with specific tasks, timelines, and responsible parties. Execute and evaluate success.

• Supervise Molina staff directly while managing vendor performance and accountability for services rendered to the contact center, ensuring operational results are achieved at minimal cost with consistent, compliant service levels and high-quality standards across all business lines.

• Ensure adherence to all state, federal, and Molina regulations, Policies/Procedures, and SOPs to maintain the highest level of compliance within Corporate Operations.

• Set and manage overall costs to meet or exceed annual budgets for all areas, seeking opportunities to enhance productivity and automation to reduce unit costs and overall G&A for the organization.

• Design and implement systematic approaches to enhance member and provider experiences through improved operational efficiency and effectiveness.

• Responsible for reporting potential financial liabilities for tracking and accruals to senior leadership.

• Demonstrate the ability to influence and drive change among peers and other stakeholders within the Molina organization.

• Possess the skill to envision, craft proposals, and gain consensus for approving and implementing future processes and systems necessary to support the strategic direction set by the organization.

• Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).

• Establish and nurture positive and effective working relationships with coworkers, clients, members, providers, and customers.

• Perform other duties as assigned.

Qualifications

Required Education
Bachelor's Degree
Required Experience/Knowledge, Skills & Abilities
10 years of experience in healthcare contact center operations.
10 years of leadership experience managing large teams.
10 years of experience overseeing operations across multiple markets and product lines, with expertise in data analytics, customer experience, workforce management, and quality metrics for operations and innovative business solutions.
Experience in developing and managing departmental budgets within set parameters.
Experience in account management with senior leadership.
Familiarity with Genesys and Salesforce platforms.
Preferred Education
Master's Degree or relevant healthcare experience.
Preferred Experience
Experience in implementing process improvements within a matrix environment.
Experience with Medicaid and Medicare systems.

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Molina Healthcare provides a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $186,201 - $363,093 / ANNUAL
*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.

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