AVP, Medicare Duals Optimization (REMOTE)

Molina Healthcare; Dayton (OH); Remote; USD 140,000 - 275,000; Full time

Job summary

A leading healthcare organization in Ohio is seeking a strategic leader to oversee the Integrated Duals program. This role requires over 10 years of experience in Managed Care, particularly in Medicare and Duals Health Plan Operations. Responsibilities include leading product development, ensuring compliance, and collaborating with multiple stakeholders to drive operational performance. Competitive pay range of $140,795 - $274,550 annually is offered.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

• At least 10 years’ experience in Managed Care, specifically in Medicare/Duals Health Plan Operations.
• Strong leadership in a matrixed environment.
• Demonstrated adaptability and flexibility in a rapidly moving business environment.

Responsibilities

• Supports strategy development and vision for integrated duals overall business.
• Leads and supports integrated duals product development and benefit strategy.
• Works with senior management to mitigate risk and implement improvements.

Skills

Leadership

Adaptability

Technical performance analysis

Proficiency in MS Office

Education

10+ years in Managed Care or equivalent

Tools

PowerPoint

Excel

Job description

Job Summary

Provides leadership to a team that is responsible for strategy, process improvements, and operational support to advance the goals and objectives of the Integrated Duals program. Supports integrated duals product development in collaboration with enterprise and health plan teams. Supports integrated teams in continual process improvement, identifying opportunities, driving projects and implementation efforts around enhanced/new processes. Partners with health plans and other enterprise teams to effectively manage and implement integrated dual products. Supports Go-To market planning for integrated duals. In partnership with other members of the Office of Duals, members of the market leadership team, responsible for optimizing operational 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

• Supports strategy development, vision and direction for integrated duals overall business and strategic objectives.
• Serves as a duals SME for enterprise and health plan teams in developing Go-To market strategies.
• Leads and supports integrated duals product development and benefit strategy for markets.
• Supports development of duals specific training.
• Coordinates accountabilities between duals office and markets to drive operational performance.
• Coordinates accountabilities between duals office and shared service to drive compliance and efficiency as well as provide oversight, including service level agreements.
• Collaborates with Medicaid business development and market leadership on mutual growth opportunities.
• Works with senior management to mitigate risk and develop/implement improvements for all operational areas that impact duals performance.
• Collaborates with compliance to ensure appropriate oversight/internal audits; develop leading indicators and alerts for all key operational metrics.
• Directs analytical activities to identify trends and potential opportunities.
• Formulate and implement business plans, tactics, and strategies to provide for efficient, effective, and compliant operations to meet short-term objectives/obligations and ensure long term growth and success.
• Works with Legal Affairs to assess and provide analyses for proposed changes to Medicare, and other government-sponsored healthcare program contracts, governing regulations and new legislation and policy requirements.
• Directs managers and/or directors of specific functional areas as assigned.
• Serves as Chief of Staff for Duals Leader.

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 Medicare SNP Plans.
• Experience with continuous process improvement strategies

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal job Board.

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

Pay Range: $140,795 - $274,550 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.