Medicare Segment Optimization Director

Molina Healthcare•Long Beach, CA

About The Position

Job Summary 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.

Requirements

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.

Nice To Haves

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

Responsibilities

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.