COO, Health Plan (Ohio)

Molina Healthcare•Long Beach, CA

8h•Onsite

About The Position

Responsible for the overall direction and administration of the operational departments, programs and services provided by the health plan. Responsibilities include: implementing programs that are in alignment with Molina's strategic plan and operating plan; providing day-to-day leadership and management of the health plan operations that mirrors the company's mission, vision, and core values; and ensure the efficient and compliant operations of the health plan. Specific areas of responsibility can include: Provider Network Management (Contracting, Provider Services, Operations), Member Services/Appeals & Grievances, Community Engagement, Project Management and Remote Office leadership and guidance.

Requirements

Bachelors' degree in Business, Health Services
Master's Degree in Business, Policy, Public Administration or Health Services Administration or related field.
15-plus year's progressive healthcare experience.
Direct experience in the managed care industry
10+ years of managed care with Medicaid and Medicare managed care plans.
Management experience.

Nice To Haves

Master's or PhD Degree in public health, social or behavioral services or similar discipline
10+ years in public health, social or behavioral services, or similar field
3+ years in a direct or matrix leadership position

Responsibilities

Serve as Health Plan point of contact
Ensure all Shared Service areas and Functions understanding priorities and issues for the Health Plan.
Collaborate with Shared Services to ensure they understand and are fulfilling Health Plan requests and commitments
Formulate and implement business plans, tactics and strategies to provide for the efficient, effective and compliant operations to meet short-term objectives/obligations and ensure long term growth and success.
Develop and implement adequate measures to meet the operational needs of the company, to efficiently utilize its resources, and to maintain an effective system of operational processes & outcome measurement.
Create new policies and amend existing policies to improve operations as needed. Present reports and recommendations on the operations of the state plan and propose changes to major policies.
Identify and drive new initiatives to optimize systems' performance and leverage functionality to: Increase claims payment accuracy and auto-adjudication, Increase members and provider satisfaction, Identify and implement cost savings initiatives in contracting, operations and employee productivity, Avoid work-arounds and unplanned re-work.
Ensure the overall level of quality for operational and contractual obligations meet or exceed appropriate standards.
Provide personal leadership that encourages employee productivity and responsiveness to the needs of the current and prospective members, providers and regulatory agencies/staff.
Ensure programs are established to comply with all relevant federal, state and local regulations.
Overall management of various departments/functions in multiple office locations which could include: Network Management and Operations, Health Plan Operations, Other Functional Areas as Needed
Project Management
Represent the Health Plan on various committees and work groups within the Shared Services Team
Represent Health Plan on MHI Committees or Operational workgroups (e.g., VPs of Network Management monthly meeting, MHI Ops Quarterly meeting with Health Plan, etc.)
Other functional areas as needed.