Director, Operational Oversight

Molina Healthcare • Owensboro, KY • 6d ago

Job Description

Job Summary

Responsible for planning, developing and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve

Knowledge/Skills/Abilities

Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to performance of internal compliance audits, represent Corporate Operations on external regulatory or associated audits, oversee function support areas requiring consistent oversight. May include travel up to 25%.

Primary liaison between regulatory auditors and corporate operations business units, leadership and line personnel from receipt of notification from regulatory agency through analysis and response to findings.

Organize audit submissions, interact directly with auditors for all lines of business as it relates to audits.

Delegation Oversight; voting representative for delegation oversight committees.

Liaison to Special Investigative Unit regarding program integrity and oversight cost expenditure.

Monitor internal compliance of Corporate Operations units via establishment of an internal compliance program, including annual, periodic, focal, etc. audits.

Request, review and perform oversight of internal corrective action plans (CAPs) for both internal and external audit findings via coordination of responses to assure appropriateness as it relates to the finding.

Performs support via review and approval for Corporate Operations policies, procedures, guidelines and job aids to assure compliance with corporate or state regulations.

Develop and maintain Corporate Operations Compliance program, including compliance policies, procedures and implementation of audits and monitoring.

Corporate Operations liaison to Corporate Legal to address legal actions, e.g. third party liability suits, provider and other such member suits.

Maintain an awareness of current laws, regulations, statutes, etc. for each state that Molina operates in that impacts Corporate Operations compliance.

Analyze and interpret with possible assistance from Molina Health Plans regulations that affect Corporate Operations policies, procedures and guidelines and work with internal leadership to assure inclusion in such documents.

Liaison for health plans for all OIG, OAG and other state office of internal/attorney general requests for data.

Liaison with the corporation's special investigative unit.

Assists with Request for Proposal responses.

Proactively work with Corporate Operations leadership on operational effective to assure compliance.

Persuade and instill effective cooperation to assure compliance via developing rapport with health plan compliance and government contract personnel..

Job Qualifications

Required Education

Bachelor's Degree or equivalent years of experience in Healthcare Administration such as oversight, audit, etc.

Required Experience

7 years of managed care experience (Regulatory and Compliance)

Previous management experience of 5 years or more

Preferred Education

Master's Degree in Healthcare Administration

Preferred Experience

10 years of managed care experience (Regulatory and Compliance)

Previous management experience of 5 years or more

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.

Pay Range: $101,721 - $206,981 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

Capital Project Supervisor

Cargill • Owensboro, KY • 22h ago

Cargill's size and scale allows us to make a positive impact in the world. Our purpose is to nourish the world in a safe, responsible and sustainable way. Cargill is a family company providing food, ingredients, agricult...

22h ago

Go to Apply

Physical Therapist

Amedisys Holding, LLC • Owensboro, KY • 1d ago

Hospital & Medical

Overview Full Time DaysAre you looking for a rewarding career in homecare? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S.Attractive pa...

1d ago

Go to Apply

Sales and Service Technician

Bridgestone Americas • Owensboro, KY • 1d ago

Management & Administrative

Company Overview Bridgestone Retail Operations (BSRO) is part of Bridgestone Americas and employs over 22,000 teammates in North America. BSRO operates more than 2,200 company-owned stores, including Firestone Complete A...

1d ago

Go to Apply

Provider Contracts Manager

Molina Healthcare • Owensboro, KY • 2d ago

Legal & Paralegal

Job Description Job Summary Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in al...

2d ago

Go to Apply

Warehouse Worker

ARAMARK • Owensboro, KY • 3d ago

Manufacturing & Warehouse

Job Description The Warehouse Worker?s main responsibilities include receiving and processing incoming products, preparing orders for transport, and performing inventory and quality control duties. This person ensures th...

3d ago

Go to Apply

Nursing Instructor

Owensboro Community & Technical College • Owensboro, KY • 4d ago

Hospital & Medical

Owensboro Community & Technical College Job Title Nursing Instructor Department NursingJob Category Faculty FLSA ExemptCollege Name Owensboro Community & Technical College Job Type Full-timeLocation Owensboro, KY...

4d ago

Go to Apply

Wireless Sales Pro

Acosta Group • Owensboro, KY • 5d ago

Sales & Marketing

Wireless Sales Pro General Information Company: PRE-US Location: OWENSBORO, Kentucky, 42301 Ref #: 89546 Function: Brand Advocacy & Sales Employment Duration: Part-time Description and Requirements Premium operates w...

5d ago

Go to Apply

Dietary Aide

Healthcare Services Group, Inc. • Owensboro, KY • 5d ago

Hospital & Medical

Overview Role: Dietary Aide Join Healthcare Services Group (HCSG) as a Dietary Aide, where you will prepare and serve meals for residents in a long-term care facility. At HCSG, we are passionate about positively impactin...

5d ago

Go to Apply

Cook

Healthcare Services Group, Inc. • Owensboro, KY • 5d ago

Retail & Hospitality

Overview Role: Cook Join Healthcare Services Group (HCSG) as a Cook, where you will play a vital role in preparing and cooking nutritious meals for residents in a long-term care facility. At HCSG, we are passionate about...

5d ago

Go to Apply

Patient Financial Advocate - Owensboro, KY

UnitedHealth Group • Owensboro, KY • 6d ago

Hospital & Medical

Opportunities at Owensboro Health , in strategic partnership with Optum. Our team of talented people works to improve the health outcomes of the communities we serve. As an Optum employee, you will provide support to the...

6d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.