Jobs
>
Long Beach

    Director, Health Plan Operations - Long Beach, United States - Molina Healthcare

    Molina Healthcare
    Molina Healthcare Long Beach, United States

    2 weeks ago

    Default job background
    Description

    Job Description

    Job Summary


    Molina Health Plan Operations jobs are responsible for the development and administration of our State Health Plan's Operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.


    Knowledge/Skills/Abilities

    • Under the leadership of the VP, Health Plan Operations, plans, organizes, staffs, and coordinates the operations of the health plan for the Medicaid , CHIP, Marketplace, MMP and Medicare lines of business.
    • Works with staff and senior management to develop and implement provider and member service strategies to improve access and satisfaction with the Plan.
    • Serves alongside the VP, Health Plan Operations as liaison for MHI Operations, including: Claims, Configuration Information Management, Provider Data Management, Credentialing, Enrollment, and Contact Center Operations.
    • Oversees Claims Operations and Configuration Information Management and works collaboratively with Corporate business owners to ensure the health plan processes for claims and encounters, aligns with regulatory requirements for each applicable line of business.
    • Oversees Enrollment and Contact Center Operations to ensure compliance with health plan requirements. Works collaboratively with Corporate business owners to mitigate risk related to enrollment processes and call center performance.
    • Oversees the Plan's Provider Network Administration activities, specifically ensuring that corporate staff receive data to load correct provider, contract and benefit configuration to support accurate claims payment and for development of accurate provider directories.
    • Oversees Provider Credentialing activities to ensure compliance with regulatory requirements.
    • Oversees the Provider Issue Research and Resolution function and the provider claim reconsideration process. Coordinates activities and executes strategies to address opportunities to improve provider satisfaction and reduce operational risk in conjunction with Provider Services.
    • Oversees the Member Appeals and Grievance process; completes analytics to identify trends; and executes strategies to improve member satisfaction.
    • Develops and executes effective member retention strategies to achieve desired retention goals. Also serves as a key partner with community outreach to achieve profitable growth.
    • Business owner of Member Stakeholder Experience team initiatives, including member static website, member web portal and Customer Relationship Management (CRM) solution. Ensures compliance with regulatory requirements and successful communication and implementation with members, employees and other key stakeholders to limit operational impact.

    Job Qualifications

    Required Education
    Bachelor's degree in Business, Health Services Administration or related field.


    Required Experience

    • 710 years' experience in Healthcare Administration, Managed Care, and/or Provider Services.
    • 35 years' experience with STAR, CHIP and STAR+PLUS Operations
    • 35 years' experience with Claims Prompt Pay laws
    • Seasoned leader with experience managing/supervising employees.
    • Demonstrated adaptability and flexibility to change and to new ideas and approaches.

    Preferred Education
    Master's degree in Business, Health Administration or related field.


    Preferred Experience

    • Experience with Medicaid and Medicare managed care plans.
    • Data analytic skills - Excel.
    • Claims
    • Provider data management systems experience.

    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:
    $87, $169,732.18 / ANNUAL

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

    Director, Health Plan Operations

    6 days ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · Molina Health Plan Operations jobs are responsible for the development and administration of our State Health Plan's Operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic p ...

  • Glovis America Inc

    Administrator - Logistics Operations Planning

    2 weeks ago

    Glovis America Inc Irvine, United States

    **About Hyundai GLOVIS America Inc.** · GLOVIS America, Inc. is a third-party logistics provider headquartered in Irvine, CA. Since our inception in 2002, we are committed to delivering our customers products via truck, rail, or ocean vessel throughout the U.S., Canada, and Mexic ...

  • Marriott International, Inc

    Guest Experience Specialist

    2 weeks ago

    Marriott International, Inc Long Beach, United States

    **Información Adicional** Pay: $22.00/hour, Front desk · **Número de Empleo** · **Categoría de Empleo** Rooms & Guest Services Operations · **Ubicación** Residence Inn Long Beach Downtown, 600 Queensway Drive, Long Beach, California, United States VER EN MAPA · **Horario** Full- ...

  • Marriott International, Inc

    Club Level Concierge

    3 weeks ago

    Marriott International, Inc Long Beach, United States

    **Información Adicional** Pay: $20.80/hour · **Número de Empleo** · **Categoría de Empleo** Rooms & Guest Services Operations · **Ubicación** Marriott Long Beach Downtown, 111 East Ocean Boulevard, Long Beach, California, United States VER EN MAPA · **Horario** Full-Time · **¿Ub ...

  • SAIC

    Intelligence Operations Planner

    3 weeks ago

    SAIC Long Beach, United States

    Job ID: · **Location**:LONG BEACH, CA, US · **Date Posted**: · **Category**:Defense/Intel · **Subcategory**:Intel Analyst · **Schedule**:Full-time · **Shift**:Day Job · **Travel**:Yes, 10 % of the Time · **Minimum Clearance Required**:TS/SCI · **Clearance Level Must Be Able to ...

  • SAIC

    Intelligence Operations Planner

    3 weeks ago

    SAIC Long Beach, United States

    Job ID: · **Location**:LONG BEACH, CA, US · **Date Posted**: · **Category**:Defense/Intel · **Subcategory**:Intel Analyst · **Schedule**:Full-time · **Shift**:Day Job · **Travel**:Yes, 10 % of the Time · **Minimum Clearance Required**:TS/SCI · **Clearance Level Must Be Able to ...

  • Molina Healthcare

    Marketplace Ops Mgr

    2 weeks ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · Knowledge/Skills/Abilities · Develop and implement strategic initiatives to achieve company growth objectives in the Individual and Family Plans (IFP) market, with a particular focus on the Health Insurance Marketplace (Exchange). · Conduct thoroug ...

  • Curtin Maritime

    Dredge Captain

    2 weeks ago

    Curtin Maritime Long Beach, United States

    **Position**:Dredge Captain · **Location**:Varies · **Department**:Operations · **Reports to**:VP of Dredging · **Schedule**:Full-time, 4 Weeks On/4 Weeks Off · - Efficiency. Innovation. Integrity. These are our 3 Pillars. At Curtin Maritime, these core values are the framework f ...

  • Molina Healthcare

    Dir, Medicare Segment Optimization

    3 weeks ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · Molina Segment leaders are responsible for the development and administration of Segment specific departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all ...

  • Long Beach Transit

    Service Development Planner

    2 weeks ago

    Long Beach Transit Long Beach, United States

    Overview: · The Service Development Planner uses their technical expertise in service planning and scheduling as well as their proficiency with transit operations performance analysis to make effective recommendations and prepare reports and study findings for system-wide continu ...

  • Molina Healthcare

    Vp, Marketplace Network Strategy and Services

    2 weeks ago

    Molina Healthcare Long Beach, United States

    Job Summary · Molina Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all re ...

  • Molina Healthcare

    Dir, Provider Relations

    2 weeks ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in complian ...

  • Hyatt Centric The Pike Long Beach

    Front Office Manager

    3 weeks ago

    Hyatt Centric The Pike Long Beach Long Beach, United States

    Summary · At Hyatt, we believe our guests select Hyatt because of our caring and attentive associates who are focused on providing efficient service and meaningful experiences. This position reports to the Director of Operations. · The Front Office Manager is responsible for all ...

  • ASM Global

    Food & Beverage Operations Manager

    3 weeks ago

    ASM Global Long Beach, United States

    Position: Food & Beverage Operations Manager · Department: Food & Beverage · Location: Long Beach Convention and Entertainment Center, managed by ASM Global · Reports To: Food & Beverage Operations Director · FLSA Status: Salaried, Exempt · Rate: $70K-$80K · Summary: Join the Sav ...

  • Molina Healthcare

    Director, Quality

    3 weeks ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · Job Duties · Serves as the primary contact to State agencies for all Risk and Quality matters. · Leads the local Quality committees. · Prepares, in collaboration and support with MHI Quality, required documentation for state Performance Improvement ...

  • Molina Healthcare

    Enterprise Crisis Response Manager

    2 weeks ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · This role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is heavily focused on business response and fully integr ...

  • Molina Healthcare

    Crisis Response Manager

    1 week ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · The Cyber Response Manager will be primarily responsible for day-to-day delivery of cyber response /crisis management program activities, including providing guidance and consultation to employees across the enterprise to ensure compliance. Support ...

  • Curtin Maritime

    Junior Project Manager

    3 weeks ago

    Curtin Maritime Long Beach, United States

    **Position**:Jr. Project Manager · **Location**:Long Beach, CA · **Department**:Marine Construction · **Reports to**:Project Manager · - Efficiency. Innovation. Integrity. These are our 3 Pillars. At Curtin Maritime, these core values are the framework for safe performance and op ...

  • Long Beach Transit

    Manager, Maintenance Planning

    2 weeks ago

    Long Beach Transit Long Beach, United States

    Overview: · Under the direction of the Executive Director/VP of Maintenance & Infrastructure, this position oversees all aspects of planning, scheduling, and budgeting for maintenance operations, ensuring the efficient and effective functioning of fleet maintenance and EAM(Enterp ...

  • Molina Healthcare

    Avp, Member Interventions

    3 weeks ago

    Molina Healthcare Long Beach, United States

    Job Description · Job Summary · The AVP, Member Initiatives is an enterprise-wide risk and quality leader focused on building, delivering, and implementing all national member-facing programs. · Molina's RQS (Risk and Quality Solutions) oversees health plans, programs, and implem ...