Senior Health Plan Operations Director

4 days ago

Albuquerque, New Mexico, United States Molina Healthcare Full time
Job Description

Molina Healthcare is seeking a highly skilled and experienced Senior Health Plan Operations Director to lead our Health Plan Operations team. As a key member of our leadership team, you will be responsible for directing and coordinating the development and administration of our Health Plan's operational departments, programs, and services.

Key Responsibilities:

  • Direct and coordinate Health Plan Operations to ensure compliance with all relevant federal, state, and local regulatory requirements.
  • Develop and implement improvements and oversight for non-clinical Health Plan operations.
  • Serve as the Senior Plan leader and liaison for MHI Service Operations, including Claims, Configuration Information Management, Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances, and other departments as required.
  • Proactively develop, track, and report to Plan leadership MHI Service Operations performance relative to Plan compliance requirements, key performance targets, and/or associated service level agreements.
  • Direct analytical activities to identify trends and potential opportunities with those Corporate Operations functions that may impact the functionality of Health Plan Operations.
  • Manage the Plan's benefit configuration, claim payment policies, and the maintenance or modification of such, to support accurate and timely claims payment.
  • Partner to support Plan encounter submissions to Regulators.
  • Lead efforts through local Data/Business Analysts to audit provider contract loads and claims payments to ensure compliance with provider contract requirements.

Requirements:

  • Bachelor's Degree in Business, Health Services Administration, or related field.
  • 7-10 years' experience in Healthcare Administration, Health Plan Operations, Managed Care, and/or Provider Services.
  • Experience managing/supervising employees.
  • Demonstrated adaptability and flexibility to a rapidly moving business environment.

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

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