Sr Specialist, Government Contracts (Medicaid) Must Live in FL

Molina Healthcare•Long Beach, CA

About The Position

Molina Healthcare of Florida is hiring a Senior Specialist in its Government Contracts department. Candidates must reside in Florida. The role provides senior-level support for government contracts activities and supports the development and administration of contracts with state and federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs that provide health care services to low-income, uninsured, and other populations in designated Molina markets. The position supports regulatory and contract operations through research, report preparation and submission, quality review of plan submissions, and verification that plans and business units meet contractual and regulatory requirements. It also reviews member- and provider-facing materials and contract reporting deliverables, distributes information from government agencies and regulators, participates in meetings with state agencies and Molina departments, maintains documentation and archives, and audits the implementation of new mandates and contract amendments.

Requirements

At least 3 years of experience in Medicaid, Medicare, and/or Marketplace health insurance or government programs, and at least 1 year of experience in government contracts, or an equivalent combination of relevant education and experience.
Knowledge of Medicaid, Medicare, Marketplace, and/or other government-sponsored programs and program compliance.
Organizational and time-management skills, including the ability to manage simultaneous projects and tasks to meet internal deadlines.
Detail orientation and analytical reasoning abilities.
Proficiency in analyzing and compiling data, creating reports, and presenting information.
Ability to work cross-functionally in a highly matrixed environment.
Effective verbal, written, and interpersonal communication skills, including the ability to communicate and present to internal and external stakeholders.
Proficiency with the Microsoft Office suite and applicable software programs.
Must reside in Florida.

Nice To Haves

Compliance-related experience.
Managed care experience, preferably Florida Medicaid and CMS.
Contracting, regulatory, or compliance experience.
Knowledge of CMS Plan.

Responsibilities

Provide senior-level support for government contracts activities.
Support the development and administration of state and federal government contracts for Medicaid, Medicare, Marketplace, and other government-sponsored programs.
Coordinate, conduct, and/or respond to research requests concerning government health care programs.
Prepare and submit regulatory reports and filings.
Review plan submissions for quality, accuracy, and timeliness, and ensure plans meet contractual and regulatory requirements.
Review provider agreements, evidence of coverage (EOC), member handbooks, provider directories, marketing materials, and other contract reporting deliverables for contractual and regulatory compliance before submission.
Assess information from government contracting agencies and regulators and disseminate it to impacted plan staff.
Participate in meetings concerning Molina government-run programs with state agencies and Molina corporate departments, and communicate relevant information to staff and leadership.
Oversee and maintain the department’s documentation and archive system, ensuring submitted reports are archived for historical and audit purposes and that the system is complete and up to date.
Conduct structured evidence reviews and audits of new regulatory mandates, contract amendments, and other operational implementations, and verify that Molina business units have implemented required changes.