AVP, Health Plan Operations - New Mexico
Company: Molina Healthcare
Location: Albuquerque
Posted on: April 16, 2024
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Job Description:
*Must live in New Mexico
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Job Description
Job SummaryMolina Health Plan Operations jobs are responsible for
the development and administration of State Health Plan's
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. -
Knowledge/Skills/Abilities
--- Under the leadership of the Plan President, this role directs
and coordinates Health Plan Operations.--- Accountable for ensuring
Health Plan Operating metrics consistently meet and/or exceed all
compliance requirements as well as key performance targets and
associated service level agreements--- This position plans,
organizes, staffs, and coordinates the operations of state
Medicaid/CHIP, Medicare and Marketplace Health Plan operations.---
Works with staff and senior management to develop and implement
improvements and oversight for non-clinical Health Plan
operations.--- Serves as the Senior Plan leader and liaison for MHI
Service Operations, including: Claims, Configuration Information
Management, Enrollment, Contact Center Operations, IT, Provider
Configuration Management, Program Integrity, Risk Adjustment,
Provider Resolution Team, Provider Appeal and Grievances, Member
Appeals and Grievances, and other departments as required. These
MHI shared services operations that support the Health Plan will
have dotted line responsibility and accountability to this
position.--- Proactively develops, tracks, and reports to Plan
leadership MHI Service Operations performance relative to Plan
compliance requirements, key performance targets and/or associated
service level agreements. Quickly escalates performance issues to
the Plan President and Plan leadership along with clear action
plans to mitigate. This role requires the identification and
adoption of best practices from across the enterprise for Health
Plan and MHI Service Operations; developing strategies and tactics
in partnership with MHI Service Operations to mitigate any issues
or performance levels not meeting established service levels and
provides corporate oversight including the efficacy of vendor
management.--- Serves as liaison with Enrollment and Contact Center
Operation leaders to ensure full and consistent compliance with
Health Plan state contract and regulatory requirements. Works
collaboratively with corporate business owners to mitigate risk
related to enrollment processes and call center performance.---
Directs analytical activities to identify trends and potential
opportunities with those Corporate Operations functions that may
impact the functionality of Health Plan Operations.--- Directly
manages the Plan's benefit configuration, claim payment policies
and the maintenance or modification of such, to support accurate
and timely claims payment. In addition, manages the Plan's Provider
Configuration/Information activities to ensure compliance with
regulatory requirements and accurate claims and encounter
submissions.--- Partners to support Plan encounter submissions to
Regulators.--- Leads efforts through local Data/Business Analysts
to audit provider contract loads and claims payments to ensure
compliance with provider contract requirements.--- May directly
manage the Project Management and Process Improvement teams and
resources.--- May directly manage the Health Plan main reception
desk at Plans discretion.--- Other operational duties as assigned
by the Plan President.. -
Job Qualifications
Required EducationBachelor's Degree in Business, Health Services
Administration or related field.Required Experience--- 7-10 years'
experience in Healthcare Administration, Health Plan Operations,
Managed Care, and/or Provider Services.--- Experience
managing/supervising employees.--- Demonstrated adaptability and
flexibility to a rapidly moving business environment.Preferred
EducationMaster's Degree in Business, Health Administration or
related field.Preferred ExperienceExperience with Medicaid and
Medicare managed care plans. -
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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.
#PJCorp
#LI-JR1 Pay Range: $122,430.44 - $238,739.35 / ANNUAL
*Actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level.
Keywords: Molina Healthcare, Albuquerque , AVP, Health Plan Operations - New Mexico, Other , Albuquerque, New Mexico
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