Director, Medicare Segment Optimization

Molina Healthcare; Dayton (OH); On-site; USD 107,000 - 251,000; Full time

Job summary

A healthcare organization is seeking an experienced leader to oversee Medicare segment operations. The ideal candidate will have over 10 years in Managed Care, strong leadership abilities, and proficiency in Microsoft Office. Responsibilities include managing performance, compliance, and regulatory risks. This position offers a competitive salary ranging from $107,028 to $250,446 annually.

Benefits

Competitive benefits package

Qualifications

• Over 10 years of experience in government programs or Medicare/Duals.
• Demonstrated adaptability to a rapidly changing environment.
• Strong proficiency in MS Office Tools.

Responsibilities

• Lead and direct Medicare segment leaders for program administration.
• Support market P&L and performance management.
• Monitor compliance and risk management.

Skills

Leadership skills

Analytical skills

Proficiency in MS Office

Adaptability

Education

10 years in Managed Care or equivalent

Tools

MS PowerPoint

MS Excel

Job description

Overview

Leads and directs Molina Medicare segment leaders who are responsible for the development and administration of Medicare segment specific 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.

Responsibilities

• 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.
• 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.
• 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.
• 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.

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.