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ATTENTION JOB SEEKERS AND MOLINA APPLICANTS: FRAUD ALERT

Be aware that third parties posing as Molina Healthcare may be soliciting money from job seekers and extending offers to candidates who have not interviewed. Molina does not engage in these type of practices. If you have received an offer and have not been engaging with Molina Healthcare in an interview process, reach out to erc@molinahealthcare.com to validate the legitimacy of your offer. Please note that Molina has reported this activity to the appropriate law enforcement agencies for further investigation. If you feel you’ve been victimized, please report it to local law enforcement.

Director, Medicare Segment Optimization (Remote within the US)

Molina Healthcare Arizona; Georgia; Kentucky; New York; Washington; Iowa; Texas; Utah; Florida; Michigan; Nebraska; Idaho; Ohio; New Mexico; Wisconsin Job ID 2028934
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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.

Pay Range: $107,028 - $250,446 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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: 11/07/2024

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