Program Director (Remote in Florida)

Molina Healthcare•Long Beach, CA

3h•Remote

About The Position

Responsible for the implementation, maintenance, and management of MHF’s Medicaid standard and expanded benefit coverage. This role will lead internal business projects and programs involving department or cross-functional teams of subject matter experts to ensure Florida Medicaid State Plan benefits, expanded benefits, and in lieu of benefits are adequately managed, including: Appropriate configuration of Medicaid benefits in our core processing systems, Strategies for the delivery and reimbursement of expanded benefits through direct service providers, vendor relationships, etc. Implementing benefit access strategies (e.g. prior authorization guidelines). Promotion of expanded benefits to improve access, utilization, and outcomes. Evaluation of existing expanded benefits and formulation of new expanded benefits. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors system analysis and program staff. Responsible for overall governance across all operational and strategic aspects of the FL Medicaid product benefits portfolio strong management and leadership skills; should be well experienced and comfortable presenting to C level executives; ability to drive structure and organization; extensive working knowledge of portfolio and project management tools and methodologies; ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing, written and verbal communication abilities; ability to handle multiple priorities and deal with ambiguity; provide oversight over the strategic and operational portfolios; manage strategic relationship with Corporate EPMO and IT. Manage the issue escalation/resolution process.

Requirements

Subject matter expertise of Florida Medicaid State Plan benefits and services, including expanded benefits, in lieu of benefits, and/or value added benefits.
Manages programs using staff and matrixed resources with oversight from AVP and VP as needed
Serves as industry Subject Matter Expert in the functional area and leads programs to meet critical needs
Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management
Consultative role, develops business case methodologies for programs, develops and coordinates implementation of business strategy
Collaborates and facilitates activities with other units at corporate and Molina Plans.
Bachelor's degree or equivalent combination of education and experience
7-9 years

Responsibilities

Implementation, maintenance, and management of MHF’s Medicaid standard and expanded benefit coverage
Lead internal business projects and programs involving department or cross-functional teams of subject matter experts
Ensure Florida Medicaid State Plan benefits, expanded benefits, and in lieu of benefits are adequately managed
Appropriate configuration of Medicaid benefits in our core processing systems
Strategies for the delivery and reimbursement of expanded benefits through direct service providers, vendor relationships, etc.
Implementing benefit access strategies (e.g. prior authorization guidelines)
Promotion of expanded benefits to improve access, utilization, and outcomes
Evaluation of existing expanded benefits and formulation of new expanded benefits
Plans and directs schedules as well as project budgets
Monitors the project from inception through delivery
Engage and oversee the work of external vendors
Assigns, directs, and monitors system analysis and program staff
Responsible for overall governance across all operational and strategic aspects of the FL Medicaid product benefits portfolio
Manage strategic relationship with Corporate EPMO and IT
Manage the issue escalation/resolution process