Associate Director jobs at HCA Healthcare - 49 jobs

VP, Medical Economics
Molina Healthcare Inc. 4.4
Columbus, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. Essential Job Duties * Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. * Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. * Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. * Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. * Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. * Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. * Informs and supports regular forecasting activities of the enterprise. * Propagates best medical economics/analysis/SAI development practices across the enterprise. * Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. * Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. Required Qualifications * At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. * At least 7 years management/leadership experience. * Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. * Extensive experience in a leadership position in health care economics, preferably with complex organizations. * Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization * Demonstrated ability to work with sophisticated analytic tools and datasets. * Demonstrated ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified information from data sources. * Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. * Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Advanced understanding of value-based risk arrangements * Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Advanced problem-solving skills. * Strong critical-thinking and attention to detail. * Excellent verbal and written communication skills. * Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications * Experience in complex managed care. * Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$186.2k-363.1k yearly 60d+ ago

Looking for a job?

Let Zippia find it for you.

Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Syracuse, NY jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
San Antonio, TX jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Cleveland, OH jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Akron, OH jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Cincinnati, OH jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Long Beach, CA jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties • Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. • Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. • Develops and promotes interdepartmental integration and collaboration to enhance clinical services. • Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. • Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. • Ensures monthly auditing is occurring with appropriate follow-up. • Engages in clinical training activities and outcomes. • Develops and mentors direct reporting healthcare services leadership. • Local travel may be required (based upon state/contractual requirements). Required Qualifications •At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • At least 3 years health care management/leadership required. • Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Experience working within applicable state, federal, and third party regulations. • Ability to manage conflict and lead through change. • Operational and process improvement experience. • Ability to work cross-collaboratively across a highly matrixed organization. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. • Medicaid/Medicare population experience. • Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
$143k-203k yearly est. Auto-Apply 5d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Dayton, OH jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Columbus, OH jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Houston, TX jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Ohio jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago
Associate Director, GME Accreditation & Operations
Community Health Systems 4.5
Remote
The Associate Director, GME Accreditation & Operations supports the oversight, development, and continuous improvement of Graduate Medical Education (GME) programs. This role collaborates with corporate and facility GME leadership to ensure program compliance, quality, and operational excellence in alignment with Accreditation Council for Graduate Medical Education (ACGME) standards. The Manager may provide guidance for new and existing program accreditations, assists in implementing quality improvement initiatives, and offers training and support to GME staff. Essential Functions Collaborates with GME leadership to develop, implement, and refine processes and procedures across clinical and educational GME settings. Provides guidance to facility GME leadership and program staff to ensure excellence in GME program operations and adherence to ACGME standards. Assists in the development and accreditation of new GME programs, providing expertise and support in accreditation processes. Leads or participates in quality improvement initiatives to enhance onboarding, training, and administrative skills for GME program staff. Acts as a resource for GME program leadership, supporting a consistent and compliant approach across all programs. Communicates effectively with corporate and facility GME teams, promoting collaboration and alignment on program goals and standards. Monitors program compliance, assesses areas for improvement, and implements strategies to enhance operational efficiency and program quality. Provides training and resources to program leaders and staff, as needed. Performs other duties as assigned. Complies with all policies and standards. Qualifications Bachelor's Degree in Healthcare Administration, Education, or a related field required Master's Degree in Education, Healthcare Administration, Organizational Leadership, or Behavioral Science/Social Work preferred 4-6 years of experience in GME administration or healthcare program management required and 3-5 years of experience as a Program/Fellowship Coordinator at an ACGME-accredited program preferred Knowledge, Skills and Abilities Strong knowledge of GME accreditation standards, including ACGME requirements. Excellent leadership and mentoring skills to guide GME administrative staff and program leadership. Effective communication and interpersonal skills to foster collaboration and alignment across GME programs. Analytical skills for program assessment, quality improvement, and compliance monitoring. Ability to manage multiple priorities and adapt to changing regulatory and operational requirements. Experience with GMETrack, ACGME ADS, Thalamus, New Innovations, and ERAS required. Licenses and Certifications Certification in GME administration or related area preferred
$77k-131k yearly est. Auto-Apply 60d+ ago
VP, Medical Economics
Molina Healthcare Inc. 4.4
Cleveland, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. Essential Job Duties * Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. * Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. * Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. * Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. * Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. * Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. * Informs and supports regular forecasting activities of the enterprise. * Propagates best medical economics/analysis/SAI development practices across the enterprise. * Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. * Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. Required Qualifications * At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. * At least 7 years management/leadership experience. * Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. * Extensive experience in a leadership position in health care economics, preferably with complex organizations. * Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization * Demonstrated ability to work with sophisticated analytic tools and datasets. * Demonstrated ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified information from data sources. * Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. * Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Advanced understanding of value-based risk arrangements * Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Advanced problem-solving skills. * Strong critical-thinking and attention to detail. * Excellent verbal and written communication skills. * Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications * Experience in complex managed care. * Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$186.2k-363.1k yearly 60d+ ago
VP, Medical Economics
Molina Healthcare Inc. 4.4
Akron, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. Essential Job Duties * Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. * Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. * Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. * Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. * Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. * Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. * Informs and supports regular forecasting activities of the enterprise. * Propagates best medical economics/analysis/SAI development practices across the enterprise. * Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. * Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. Required Qualifications * At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. * At least 7 years management/leadership experience. * Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. * Extensive experience in a leadership position in health care economics, preferably with complex organizations. * Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization * Demonstrated ability to work with sophisticated analytic tools and datasets. * Demonstrated ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified information from data sources. * Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. * Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Advanced understanding of value-based risk arrangements * Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Advanced problem-solving skills. * Strong critical-thinking and attention to detail. * Excellent verbal and written communication skills. * Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications * Experience in complex managed care. * Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$186.2k-363.1k yearly 60d+ ago
VP, Medical Economics
Molina Healthcare 4.4
Akron, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. **Essential Job Duties** - Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. - Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. - Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. - Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. - Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. - Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. - Informs and supports regular forecasting activities of the enterprise. - Propagates best medical economics/analysis/SAI development practices across the enterprise. - Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. - Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. **Required Qualifications** - At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. - At least 7 years management/leadership experience. - Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. - Extensive experience in a leadership position in health care economics, preferably with complex organizations. - Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization - Demonstrated ability to work with sophisticated analytic tools and datasets. - Demonstrated ability to convert observations into actions/interventions to improve financial performance. - Advanced understanding of Medicaid and Medicare programs or other health care plans. - Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) - Advanced proficiency with retrieving specified information from data sources. - Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. - Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) - Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). - Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. - Advanced understanding of value-based risk arrangements - Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. - Advanced problem-solving skills. - Strong critical-thinking and attention to detail. - Excellent verbal and written communication skills. - Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. **Preferred Qualifications** -Experience in complex managed care. - Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$186.2k-363.1k yearly 60d+ ago
VP, Medical Economics
Molina Healthcare Inc. 4.4
Dayton, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. Essential Job Duties * Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. * Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. * Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. * Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. * Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. * Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. * Informs and supports regular forecasting activities of the enterprise. * Propagates best medical economics/analysis/SAI development practices across the enterprise. * Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. * Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. Required Qualifications * At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. * At least 7 years management/leadership experience. * Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. * Extensive experience in a leadership position in health care economics, preferably with complex organizations. * Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization * Demonstrated ability to work with sophisticated analytic tools and datasets. * Demonstrated ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified information from data sources. * Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. * Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Advanced understanding of value-based risk arrangements * Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Advanced problem-solving skills. * Strong critical-thinking and attention to detail. * Excellent verbal and written communication skills. * Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications * Experience in complex managed care. * Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$186.2k-363.1k yearly 60d+ ago
VP, Medical Economics
Molina Healthcare 4.4
Dayton, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. **Essential Job Duties** - Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. - Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. - Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. - Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. - Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. - Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. - Informs and supports regular forecasting activities of the enterprise. - Propagates best medical economics/analysis/SAI development practices across the enterprise. - Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. - Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. **Required Qualifications** - At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. - At least 7 years management/leadership experience. - Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. - Extensive experience in a leadership position in health care economics, preferably with complex organizations. - Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization - Demonstrated ability to work with sophisticated analytic tools and datasets. - Demonstrated ability to convert observations into actions/interventions to improve financial performance. - Advanced understanding of Medicaid and Medicare programs or other health care plans. - Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) - Advanced proficiency with retrieving specified information from data sources. - Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. - Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) - Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). - Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. - Advanced understanding of value-based risk arrangements - Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. - Advanced problem-solving skills. - Strong critical-thinking and attention to detail. - Excellent verbal and written communication skills. - Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. **Preferred Qualifications** -Experience in complex managed care. - Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$186.2k-363.1k yearly 60d+ ago
VP, Medical Economics
Molina Healthcare Inc. 4.4
Ohio jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. Essential Job Duties * Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. * Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. * Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. * Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. * Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. * Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. * Informs and supports regular forecasting activities of the enterprise. * Propagates best medical economics/analysis/SAI development practices across the enterprise. * Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. * Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. Required Qualifications * At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. * At least 7 years management/leadership experience. * Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field. * Extensive experience in a leadership position in health care economics, preferably with complex organizations. * Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization * Demonstrated ability to work with sophisticated analytic tools and datasets. * Demonstrated ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified information from data sources. * Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. * Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Advanced understanding of value-based risk arrangements * Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Advanced problem-solving skills. * Strong critical-thinking and attention to detail. * Excellent verbal and written communication skills. * Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications * Experience in complex managed care. * Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$186.2k-363.1k yearly 60d+ ago
VP De Novo Sourcing, USPI - Carolinas & Tennessee
Tenet Healthcare 4.5
Remote
COMPANY BACKGROUND: Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas. Our care delivery network includes United Surgical Partners International, the largest ambulatory platform in the country, which operates ambulatory surgery centers and surgical hospitals. We also operate a national portfolio of acute care and specialty hospitals, other outpatient facilities, a network of leading employed physicians and a global business center in Manila, Philippines. Our Conifer Health Solutions subsidiary provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers, and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve. For more information, please visit ********************** ************* JOB DESCRIPTION: A De Novo Vice President (“DNVP”) will lead efforts to grow USPI's pipeline of newly constructed outpatient surgical facilities (de novos). This position is responsible for leading sourcing efforts and USPI enterprise approach to building new ASC partnerships with physicians in the Carolinas & Tennessee. The role will include extensive engagement and relationship development with physicians as well as identifying and driving viable opportunities to successful syndication. The DNVP will be responsible for company-wide capital development projects, with frequent travel required in order to effectively lead and execute on team initiatives. Creativity, innovation, self-reliance, organization and relationship-driven thinking are keys to success in this position. This role is responsible for educating providers on the benefits of a surgical center investment and appropriately explaining the USPI value proposition and differentiators that make a partnership with USPI successful. All provider engagement is to be done in accordance with the Company's Standards of Conduct and policies and procedures, particularly those involving referral source arrangements REQUIRED SKILLS: Bachelor's Degree Required. At least 7 years of experience in a field related to health system physician relations, pharmaceuticals, or medical devices Extensive experience working with physicians and within healthcare organizations whose recognition and reputation for excellence and quality place them at or near the top of the healthcare delivery system. Represent the organization at all times. Be supportive of other managers and set an example of high personal and professional conduct and integrity for employees and others. Ability to identify strategic priorities and drive them to completion. Embrace collaborative leadership style; ability to seek input and counsel from a wide constituency, without losing decisiveness or the ability to take action and inspire others to action, as appropriate. OTHER REQUIREMENTS: Exhibited success in a business development / sales role Demonstrate excellent organizational, interpersonal, facilitation, and communication skills Capacity to work independently with minimal supervision Ability to travel up to 50% of time. Selected candidate will be required to pass a Motor Vehicle Record check. #LI-CD1 RESPONSIBILITIES AND EXPECTATIONS Lead the sourcing efforts for de novo projects by enhancing company sourcing strategy around people, process, and pipeline approach. Assess market dynamics, physician practice trends, and competition to inform and prioritize strategies around new facility demand and growth. Research physicians to understand the decision making behind facility selection and other ASC and / or hospital relationships the providers may have. This information should inform provider engagement. Maintain a robust pipeline of active external physician recruits, effectively communicate USPI centers' value proposition, and facilitate new physician starts at USPI centers Foster, nurture, and maintain relationships with USPI's potential and existing physician partners to drive new opportunities for the company. Maintain latest knowledge of the market hospital, ambulatory surgery, and provider landscape in the defined market service area. Assist in the formation of JV partnerships and the syndication of ownership interests to physicians, including financial projections, preparation of syndication documents, etc. Identify and help guide process improvement opportunities across de novo sourcing and execution. Partner with USPI business leaders before, during and after projects are complete to ensure they make strategic sense, fit with forward-looking business plans, and are integrated smoothly and fully optimized.
$136k-195k yearly est. Auto-Apply 22d ago
Director, Healthcare Services (remote in CST / MST / PST)
Molina Healthcare 4.4
Fort Worth, TX jobs
Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. This role will support operational needs 5am - 7pm PST. Working hours may vary and coverage will include Mon. - Sat. and some Holidays. Essential Job Duties - Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. - Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. - Develops and promotes interdepartmental integration and collaboration to enhance clinical services. - Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. - Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. - Ensures monthly auditing is occurring with appropriate follow-up. - Engages in clinical training activities and outcomes. - Develops and mentors direct reporting healthcare services leadership. - Local travel may be required (based upon state/contractual requirements). Required Qualifications -At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership required. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - Experience working within applicable state, federal, and third party regulations. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Ability to work cross-collaboratively across a highly matrixed organization. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.
$88.5k-207k yearly 4d ago