Director, Operational Oversight (REMOTE)

Molina Healthcare • Milwaukee, WI • 14h 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

PRN Physical Therapist Assistant

Enhance Rehabilitation • Milwaukee, WI • 7h ago

Hospital & Medical

Enhance Rehabilitation is currently seeking qualified physical therapy assistant candidates to join our dynamic team. As an Enhance Rehabilitation physical therapist assistant, working under the guidance of a physical th...

7h ago

Go to Apply

PRN Physical Therapist (PT)

Enhance Rehabilitation • West Allis, WI • 7h ago

Hospital & Medical

Enhance Rehabilitation is currently seeking qualified Physical Therapists candidates to join our dynamic team. As an Enhance Rehabilitation Physical Therapist, you will be a part of growing team providing the highest qua...

7h ago

Go to Apply

Part Time Physical Therapist

Enhance Rehabilitation • Milwaukee, WI • 7h ago

Hospital & Medical

Sign on Bonus-$2,000!!! Salary: $40-$45/hour Unlimited online CEU's Enhance Rehabilitation is currently seeking qualified Physical Therapists candidates to join our dynamic team. As an Enhance Rehabilitation Physical The...

7h ago

Go to Apply

Physical Therapist (PT)

Enhance Rehabilitation • Brookfield, WI • 7h ago

Hospital & Medical

Sign on Bonus!!! $78-$90k Enhance Rehabilitation is dedicated to providing quality rehabilitation services to our patients. Our goal is to provide patient specific treatments to enhance positive outcomes. We focus on pro...

7h ago

Go to Apply

Manager Marketing Product Management

API HEAT TRANSFER INC • Franklin, WI • 12h ago

Management & Administrative

JOB REQUIREMENTS: Now Hiring: Manager, Marketing & Product Management --- GT Location: Franklin, WITravel:15-20%Reports to: VP of Sales GT Are you a strategic thinker with a passion for digital innovation and product...

12h ago

Go to Apply

Outside Sales Representative

ADVANTAGE CRYSTAL INC • Milwaukee, WI • 12h ago

Sales & Marketing

JOB REQUIREMENTS: Earn, Learn, and Grow with Advantage xPO Outside Sales Representative Location Milwaukee, WI area If you\'re ready to determine your paycheck, Advantage xPO has what you\'re looking for. This opportunit...

12h ago

Go to Apply

Sr. Manager Accounting - SRMAN013997

GOODWILL INDUSTRIES OF SE WISCONSIN • Milwaukee, WI • 13h ago

Finance & Accounting

JOB REQUIREMENTS: Sr. Manager Accounting - SRMAN013997 DESCRIPTION/RESPONSIBILITIES: The Senior Manager Accounting will lead the development and enforcement of accounting policies and procedures, ensuring compliance with...

13h ago

Go to Apply

AM (Breakfast) Server

Crescent Hotels and Resorts • Brookfield, WI • 13h ago

Description Working Hours: 5am - 11am JOB OVERVIEW: Greet and serve the guests according to standards. ESSENTIAL JOB FUNCTIONS: Take and serve guest orders promptly and according to service manual. Do all necessary set-u...

13h ago

Go to Apply

Director Data Measurement

UNITED WAY OF GRTR MKE & WAUK CNTY • Milwaukee, WI • 13h ago

IT & Engineering

JOB REQUIREMENTS: Job Title: Director, Data & Measurement (Non-Union) Status: Full-Time Department: Information Technology Grade: Management Date: July 2025 FLSA Status: Exempt SUMMARY This role provides technical le...

13h ago

Go to Apply

Bartenders - Weekend Hours

Crescent Hotels and Resorts • Milwaukee, WI • 13h ago

Retail & Hospitality

Description At Crescent Hotels & Resorts, we are a team of hospitality professionals that are deeply connected to and proud of the exceptional experiences we provide for our guests. More than that, we know our Associ...

13h 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.