Provides deep subject matter expertise and leadership for the optimization of the Medicare segment product.  Develops and monitors performance indicators to ensure key operational metrics are achieved, and collaborates cross-functionally across the enterprise with health plan leadership and shared services to ensure Medicare performance objectives and goals are met, including membership, quality, and financial specific targets.  Evaluates cross-functional processes and activities and provides recommendations for process and performance improvements.

Essential Job Duties

• Under the direction of Medicare segment senior leadership, facilitates transparent and compliant execution of Medicare performance objectives and goals.
• Directs implementation, monitoring, and measurement of strategic and tactical plans that contribute to segment and health plan growth and achievement of performance objectives. 
•  Coordinates accountabilities between segment and markets to drive performance in network, risk adjustment, and Medicare Stars; acts as the 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, and provides oversight, including oversight of service level agreements (SLAs).
• Collaborates with staff and leadership to mitigate risk and develop/implement improvements across areas that impact Medicare performance.
• Collaborates across the Medicare segment (includes health plans and enterprise shared services) to ensure appropriate performance objectives are met; develops leading indicators and alerts for all key operational metrics.
• Analyzes activities and identifies trends and potential opportunities within Medicare segment to achieve performance objectives at state and enterprise levels.
• Develops ownership and outcome recommendations for processes that cross functions – segment, enterprise operations, etc.
 

Required Qualifications

• At least 8 years of experience in health care operations - specifically government programs (Medicare, Medicaid, Medicare-Medicaid Plan (MMP), Special Needs Plan (SNP)), or equivalent combination of education and experience.  
• At least 3 years management/leadership experience.
• Strong leadership experience in a matrixed environment.
• Adaptability and flexibility to rapidly moving business environment.
• Background analyzing technical performance and driving teams to improvement. 
• Demonstrated ability to drive large-scale change management within a complex and geographically dispersed organization.
• Ability to present strategies and goals in an inspirational manner to large cross-functional teams.
• Ability to make sound decisions in ambiguous or difficult situations, synthesizing information from multiple sources and use it for effective decision-making.
• Strong interpersonal skills.
• Ability to collaborate cross-functionally.
• Excellent verbal and written communication skills.  
• Microsoft Office suite proficiency (including PowerPoint and Excel), and applicable software program(s) proficiency.
 

Preferred Qualifications

• Experience with Medicare Special Needs Plan (SNP) and Medicare-Medicaid Plan (MMP).
 

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