Program Operations Manager

Molina Healthcare • Racine, WI • 8h ago

Job Description

Job Summary

The In-Home Assessment Program Manager is part of our innovative Risk Adjustment department to assist our diverse team of data leaders, risk adjustment experts, and developers in the development and implementation of business strategies, operations and vendor management related to in-home assessment activities in all government lines of business impacted by the regulatory risk adjustment payment model.

They will be assist with implementing and managing the in-home assessment program that leads to the overall achievement of improved risk score accuracy, compliancy and completeness in risk adjustment revenue for all government lines of business to better support overall population heath management, reduce gaps in care and drive medical loss ratio (MLR) targets. In conjunction with the Manager of the In-Home Assessment Program, this role supports the strategic direction and organization of corporate initiatives to facilitate achievement of the in-home assessment program.

Knowledge/Skills/Abilities

This role interacts and supports regulatory agency policy and procedures by acting as a key business partner to the Director, Prospective Programs, Market & Segment Leaders, health plan teams, member services, provider services, external vendors, actuary, and finance. Direct reports to the manager include program specialist.

The position's essential functions are as follows:

Collaborates with colleagues to implement and manage in-home assessment program and contracted vendors.

Responsible for tracking and monitoring success of in-home assessment program against set goals, develops corrective action plans for program and partnering vendors, communicates program progress.

Develops and maintains program work plans, workflows, and related program documentation.

Oversees day-to-day vendor relationship, invoice payments, performance, issue resolution, and corrective action plans as needed.

Maintains compliance with all policies and procedures.

Adheres to all confidentiality and HIPAA requirements as outlined within Policies and Procedures in all ways and at all times with respect to any aspect of the data handles or services rendered in the undertaking of the position.

Fulfills those responsibilities and/or duties that may be reasonably provided by Molina for the purpose of achieving operational and financial success of the Company..

Job Qualifications

Required Education

Associates or Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience

Required Experience

3 years managed care experience, preferably with a national or multi-location organization

Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliancy

Proven ability to innovate and drive organizational change

Excellent presentation and communication skills

Preferred Education

Graduate Degree preferred

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: $77,969 - $155,508 / ANNUAL

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

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