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 Administration (Regulatory SME) - REMOTE
Molina Healthcare Lexington-Fayette, Kentucky; Everett, Washington; Boise, Idaho; Savannah, Georgia; Davenport, Iowa; Houston, Texas; Mesa, Arizona; Washington; Akron, Ohio; Jacksonville, Florida; Bowling Green, Kentucky; Grand Rapids, Michigan; Salt Lake City, Utah; Spokane, Washington; Bellevue, Washington; Owensboro, Kentucky; Detroit, Michigan; Fort Worth, Texas; Rio Rancho, New Mexico; Tucson, Arizona; Georgia; Layton, Utah; Dayton, Ohio; Santa Fe, New Mexico; Madison, Wisconsin; Sioux City, Iowa; Nampa, Idaho; Scottsdale, Arizona; Tampa, Florida; Louisville, Kentucky; Columbus, Georgia; Cedar Rapids, Iowa; Michigan; Nebraska; Buffalo, New York; Austin, Texas; Omaha, Nebraska; Macon, Georgia; Vancouver, Washington; Dallas, Texas; Warren, Michigan; Rochester, New York; Iowa; Cleveland, Ohio; Las Cruces, New Mexico; Yonkers, New York; Ann Arbor, Michigan; Meridian, Idaho; Kenosha, Wisconsin; Cincinnati, Ohio; Des Moines, Iowa; Columbus, Ohio; Ohio; Texas; Atlanta, Georgia; Miami, Florida; Wisconsin; Iowa City, Iowa; San Antonio, Texas; Phoenix, Arizona; Orem, Utah; West Valley City, Utah; Roswell, New Mexico; Augusta, Georgia; Utah; Racine, Wisconsin; Sterling Heights, Michigan; Bellevue, Nebraska; Covington, Kentucky; Orlando, Florida; Grand Island, Nebraska; Idaho Falls, Idaho; Milwaukee, Wisconsin; Chandler, Arizona; Kentucky; New Mexico; Idaho; New York; Caldwell, Idaho; Provo, Utah; Kearney, Nebraska; Florida; Albuquerque, New Mexico; Syracuse, New York; Albany, New York; Lincoln, Nebraska; Tacoma, Washington; Green Bay, Wisconsin; St. Petersburg, Florida Job ID 2032365JOB DESCRIPTION
Job Summary
Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services.
KNOWLEDGE/SKILLS/ABILITIES
- Establishes audit controls and measurements to ensure correct processes are established. Develops and performs internal audits/risk assessments, monitoring program for Molina Healthcare departments. Provides post audit findings and recommendations to ensure contractual State and Federal Compliance.
- Coordinates development of written policies and procedures regarding compliance with local, state and federal guidelines.
- Establishes member grievance appeals and policies and updates annually or as directed by the Centers for Medicare and Medicaid Services.
- Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the Center for Medicare and Medicaid.
- Responsible for development, implementation, and maintenance of department strategic initiatives.
JOB QUALIFICATIONS
Required Education
Graduate Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Experience
10+ years
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: $88,453 - $172,981 / 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 06/13/2025Job Alerts
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