Medicare Segment Optimization Director - Molina Healthcare : Job Details

Job Description

Job Summary

Drives and directs the overall performance of assigned D-SNP markets. Serves as the D-SNP market lead responsible for individual market P&L performance 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

• Enable market P&L success through support and oversight for assigned markets, including D-SNP market performance management.

• Function as Medicare subject matter expert and point of contact for assigned market.

• Monitor and support sales and retention efforts.

• Monitor compliance and regulatory risks.

• Contribute to and present in market performance review meetings.

• Collaborate with Network teams on value-based services.

• Partner with Government Contracts on regulatory items

• 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.

• Collaborate 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 the 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.

• Support Health Plan Scorable Action Items (SAIs) to ensure performance and quality levels exist in line with Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements.

• 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 QUALIFICATIONS:

• At least 10 years' experience in Managed Care, specifically government programs and/or Medicare/Duals Health Plan Operations, or equivalent combination of education and experience

• Strong leadership in a matrixed environment

• Demonstrated adaptability and flexibility to a rapidly moving business environment.

• 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 QUALIFICATIONS:

• 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.