Director, Operational Oversight (REMOTE)

Molina Healthcare • Roswell, NM • 1w 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: $88,453 - $206,981 / ANNUAL

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

Similar Jobs

Data Scientist - Generative AI/ML/Databricks - Remote

Molina Healthcare • Roswell, NM • 5h ago

IT & Engineering

Job Description Job Summary Perform data and error analysis to improve models, and clean and validate data for uniformity and accuracy. Execute data science and statistical analytical experiments methodically to help sol...

5h ago

Go to Apply

Sr Data Scientist - Generative AI/ML/Databricks - Remote

Molina Healthcare • Roswell, NM • 6h ago

IT & Engineering

6h ago

Go to Apply

Actuarial Analyst (Medicaid Risk Adjustment) - REMOTE

Molina Healthcare • Roswell, NM • 16h ago

JOB DESCRIPTION Job Summary Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk adjustment model, estimate risk scores, and analyze impact. Extrac...

16h ago

Go to Apply

Manager, Operations (Remote)

Molina Healthcare • Roswell, NM • 1d ago

Management & Administrative

Job Description Job Summary Provides leadership and direction to MMS Operational Units management staff (e.g., Claims Processing, Provider Services, Provider Enrollment, Finance, Managed Care Provider Network), for manag...

1d ago

Go to Apply

OPERATIONS ASSISTANT MANAGER

Dollar Tree • Roswell, NM • 1d ago

Retail & Hospitality

Store Dollar Tree Work where you love to shop! Dollar Tree is hiring in your neighborhood. Avoid long commutes and set your own course to success by applying today. We offer generous benefits, flexible work schedules and...

1d ago

Go to Apply

Sr Data Scientist - ML/AI/Databricks - Remote

Molina Healthcare • Roswell, NM • 1w ago

IT & Engineering

1w ago

Go to Apply

Care Review Processor

Molina Healthcare • Roswell, NM • 1w ago

JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum...

1w ago

Go to Apply

Clinical Appeals Nurse (RN)

Molina Healthcare • Roswell, NM • 1w ago

Hospital & Medical

JOB DESCRIPTION Job Summary Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards. KNOWLEDGE/SKILLS/ABILITIES The Clinical Appeals Nurse (R...

1w ago

Go to Apply

Registered Nurse, RN

Genesis Healthcare • Roswell, NM • 2w ago

Hospital & Medical

Overview At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fost...

2w ago

Go to Apply

Provider Contracts Manager

Molina Healthcare • Roswell, NM • 2w 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...

2w 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.