Remote Prominence Health Plan Jobs Near Me

Job Description 
Job Summary 
Responsible for the overall direction and administration of the operational departments, programs and services provided by the health plan. Responsibilities include: implementing programs that are in alignment with Molina's strategic plan and operating plan; providing day-to-day leadership and management of the health plan operations that mirrors the company's mission, vision, and core values; and 
ensure the efficient and compliant operations of the health plan. Specific areas of responsibility can include: Provider Network Management (Contracting, Provider Services, Operations), Member Services/Appeals & Grievances, Community Engagement, Project Management and Remote Office leadership and guidance. 
 

Preferred Work Location - Ohio

Knowledge/Skills/Abilities 
Duties and Responsibilities (List all essential duties and responsibilities in order of importance) 
Serve as Health Plan point of contact 
Ensure all Shared Service areas and Functions understanding priorities and issues for the Health Plan. 
Collaborate with Shared Services to ensure they understand and are fulfilling Health Plan requests and commitments 
Formulate and implement business plans, tactics and strategies to provide for the efficient, effective and compliant operations to meet short-term objectives/obligations and ensure long term growth and success. 
Develop and implement adequate measures to meet the operational needs of the company, to efficiently utilize its resources, and to maintain an effective system of operational processes & outcome measurement. 
Create new policies and amend existing policies to improve operations as needed. Present reports and recommendations on the operations of the state plan and propose changes to major policies. 
Identify and drive new initiatives to optimize systems' performance and leverage functionality to: 
o Increase claims payment accuracy and auto-adjudication 
o Increase members and provider satisfaction 
o Identify and implement cost savings initiatives in contracting, operations and employee productivity 
o Avoid work-arounds and unplanned re-work. 
Ensure the overall level of quality for operational and contractual obligations meet or exceed appropriate standards. 
Provide personal leadership that encourages employee productivity and responsiveness to the needs of the current and prospective members, providers and regulatory agencies/staff. 
Ensure programs are established to comply with all relevant federal, state and local regulations. 
State Plan / Department Specific Duties and Responsibilities (List all essential duties other than those listed above in order of importance) 
Overall management of various departments/functions in multiple office locations which could include: 
o Network Management and Operations 
o Health Plan Operations 
o Other Functional Areas as Needed 
Other duties: 
o Project Management 
o Represent the Health Plan on various committees and work groups within the Shared Services Team 
o Other duties as requested 
o 
o Operational and Communication work groups 
o 
o Project Management 
o Represent Health Plan on MHI Committees or Operational workgroups (e.g., VPs of Network Management monthly meeting, MHI Ops Quarterly meeting with Health Plan, etc.) 
o Other functional areas as needed. 
  Job Qualifications

Required Education
Bachelors' degree in Business, Health Services Master's Degree in Business, Policy, Public Administration or Health Services Administration or related field.
Required Experience
15-plus year's progressive healthcare experience. Direct experience in the managed care industry; 10+ years of managed care with Medicaid and Medicare managed care plans. Management experience.
Preferred Education
Master's or PhD Degree in public health, social or behavioral services or similar discipline
Preferred Experience
10+ years in public health, social or behavioral services, or similar field; 3+ years in a direct or matrix leadership position
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.