Director, Health Plan Operations: Remote - New Mexico - Leading Healthcare Administration with Molina Healthcare

Transforming Healthcare through Operational Excellence

Molina Healthcare, a renowned leader in healthcare management, is seeking an exceptional Director, Health Plan Operations to join their team on a remote basis in New Mexico. As a pivotal member of the organization, this role is responsible for overseeing the development and administration of operational departments, programs, and services that align with Molina Healthcare's mission, core values, and strategic plan.

About Molina Healthcare and the Healthcare Industry

Molina Healthcare is a trusted name in the healthcare industry, dedicated to providing quality healthcare services to millions of Americans. With a strong presence in Medicaid, CHIP, Marketplace, MMP, and Medicare lines of business, the company is committed to improving the health and well-being of its members. As a Director, Health Plan Operations, you will play a crucial role in shaping the company's operational strategies and ensuring compliance with federal, state, and local regulations.

Key Responsibilities

• Leadership and Strategy: Under the guidance of the VP, Health Plan Operations, plan, organize, staff, and coordinate the operations of the health plan across various lines of business.
• Provider and Member Services: Collaborate with staff and senior management to develop and implement strategies that enhance provider and member satisfaction.
• Liaison for MHI Operations: Serve as a liaison for MHI Operations, including Claims, Configuration Information Management, Provider Data Management, Credentialing, Enrollment, and Contact Center Operations.
• Operational Oversight: Oversee Claims Operations, Configuration Information Management, Enrollment, Contact Center Operations, Provider Network Administration, Provider Credentialing, and Member Appeals and Grievance processes.
• Compliance and Risk Management: Ensure compliance with regulatory requirements and mitigate operational risk across various departments.
• Member Retention and Growth: Develop and execute effective member retention strategies and partner with community outreach to achieve profitable growth.
• Business Ownership: Own Member Stakeholder Experience team initiatives, including member static website, member web portal, and Customer Relationship Management (CRM) solution.

Essential Qualifications and Skills

Education and Experience

• Bachelor's Degree: Business, Health Services Administration, or a related field.
• Experience: 7-10 years in Healthcare Administration, Managed Care, and/or Provider Services.
• Specific Experience: 3-5 years with STAR, CHIP, and STAR+PLUS Operations, and 3-5 years with Prompt Pay laws.
• Leadership Experience: Seasoned leader with experience managing/supervising employees.

Skills and Competencies

• Adaptability and Flexibility: Demonstrated ability to adapt to change and new ideas.
• Strategic Thinking: Ability to develop and implement effective strategies.
• Communication: Excellent communication and interpersonal skills.
• Analytical Skills: Ability to analyze data and identify trends.

Preferred Qualifications

• Master's Degree: Business, Health Administration, or a related field.
• Experience with Medicaid and Medicare Managed Care Plans: Prior experience working with Medicaid and Medicare managed care plans is highly desirable.

Career Growth and Learning Opportunities

As a Director, Health Plan Operations at Molina Healthcare, you will have opportunities to grow professionally and develop your skills in healthcare administration. You will be part of a dynamic team that is committed to delivering high-quality healthcare services and improving the health and well-being of its members.

Work Environment and Company Culture

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V, committed to diversity and inclusion. The company offers a competitive benefits and compensation package, and a work environment that values flexibility and work-life balance. As a remote employee, you will have the opportunity to work from anywhere, while still being connected to a talented team of professionals.

Compensation and Benefits

Molina Healthcare offers a competitive salary range of $87,568.7 - $189,732.18 per annum, depending on experience and qualifications. The company also provides a comprehensive benefits package, including opportunities for professional growth and development.

Join Our Team

If you are a seasoned healthcare professional looking for a challenging and rewarding role, we encourage you to apply for this exciting opportunity. As a Director, Health Plan Operations at Molina Healthcare, you will play a critical role in shaping the company's operational strategies and improving the health and well-being of its members. Apply now and join our team of dedicated professionals!