Medicare Segment Optimization Director

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*
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* REQUIRED QUALIFICATIONS:

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* + 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.

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* PREFERRED QUALIFICATIONS:

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Experience with DSNP.

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: $96,325.57 - $208,705.4 / ANNUAL

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