Regional Medicare Director SNP/MMP Plan Support (4844BR) Long Beach, California
MOLINA HEALTHCARE - REGIONAL MEDICARE DIRECTOR SNP/MMP PLAN SUPPORT
This position plans, organizes and coordinates a set of core Medicare activities across all markets. In addition, this position connects health plans to departments that support Medicare and MMP plan functions, including Medicare, by serving as a product expert and the primary resource to plan presidents and senior leadership teams in either the eastern or the western region of the U.S.
Duties and Responsibilities:
• This position connects health plans to departments that support Medicare and MMP plan functions, including Medicare, by serving as a product expert and the primary resource to plan presidents and senior leadership teams in either the eastern or the western region of the U.S.
o In that aspect of this position, the director prepares reports for, and runs, monthly meetings with plan presidents and their SLT
• In addition, along with one other regional director, this position plans, organizes and coordinates a set of core Medicare activities across all markets.
• These activities include one off projects, such as:
o Research on operational questions, such as how can nurses look up inpatient reserve days for hospital coverage and psych
o Managing changes to non-par payment policies, including analysis, executive decision making, and driving a multi-functional team to a desired outcome
o Filling roles necessary for the company to achieve its risk adjustment goals
o Ensuring MOOP is appropriately tracked and cost share is activated for members until their MOOP limits are reached
o Ensuring Molina’s MSP/COB processes aligns with Molina’s revenue objectives
o Creating presentations on operational topics for senior leadership
• The activities also include the following recurring responsibilities:
o Co-managing a team of 10 analysts and specialists
o Managing the annual product implementation lifecycle- owning the core training deck and making updates; writing BRDs etc.
o Creating copy for member materials that describe OTC, and other supplemental benefits
o CTM root cause analysis
o Developing and executing Stars improvement operational initiatives
o Ensuring claims and member services perform consistent with internal and regulatory requirements
o Paying capitated groups and supplemental vendors
o Supporting the sales department on analytics and back office work such as payment and maintenance of broker files
Knowledge, Skills and Abilities
• High levels of SME on Medicare and operations related to at least two of the following areas: customer services, provider services, claims, member grievances and appeals, non-contracted provider appeals, and benefits administration.
• Ability to interpret regulatory guidance and comply with regulatory agencies
• Ability to identify and develop talent and lead a team
• Ability to work across matrixed departments
• Excellent verbal and written communication skills
List other duties which are of secondary importance and marginal to the job’s purpose.
• Other duties as assigned.
Bachelor’s Degree in Business Administration, Public Health, Health Services Administration, Health Sciences or related health care field.
Master’s Degree in Business Administration
• 8+ years management experience in at least two of the following operational areas: customer services, member grievances and appeals, benefits administration, claims or provider services.
• 8+ years experience in Medicare Operations
8+ years supervising staff of 5+ persons
Experience with Medicare annual cycle for NOIAs, Network Adequacy standards. Benefit and Bid development and submission, Member Materials, and Enrollment.