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Regional Director jobs at HCA Healthcare
- 35 jobsRegional Coding Operations Manager WFH
HCA
Regional director job at HCA Healthcare
is incentive eligible. Job Summary and Qualifications The Regional Coding Operations Manager (RCOM) is responsible for assisting in the development and evolution of the overall strategy for Physician Services Group (PSG) Coding Operations. The RCOM is responsible for oversight of all PSG coding operational processes and workflow, including but not limited to, practice acquisitions, provider clinical documentation improvement, practice coding processes, and division relationship management as applicable. The RCOM assists the Regional Coding Operations Director with the oversight and implementation of Coding Operations operational planning, service commitment, budgets, workflow processes and internal controls. As the RCOM, this person serves as a key promoter of Coding Operations and is responsible for setting the tone of Coding Operations as a service organization, continuously seeking to understand, meet, and exceed customer expectations and needs. * This position is considered Work from Home and will support our practices in the Fort Lauderdale and Miami markets. This leader must be based in the Miami, Fort Lauderdale or surrounding areas or be willing to relocate to the area in order to support our practices across the division. * Job Summary and Qualifications * Provides coding and documentation improvement education to Providers. * Assists the Director Coding Operations Division Support in reviewing progress against business case expectations and operational metrics to ensure that financial and operational risks are properly managed. * Works with the division operations team and CCU team on practice implementation/acquisition activities and projects. * Leads key communication efforts with practice staff, providers, and Division Leadership. * Provides direction and guidance to the practice management and Division Leadership teams to ensure accurate and efficient coding processes. * PSG Coding Operations works with Central Coding Unit (CCU) to identify and resolve issues. * Works collaboratively with each practice and division leadership team to ensure customer satisfaction and efficient coding work processes. * Assists the coding process in serving as a liaison between the CCU team and practice management, including the providers and division leadership while building and maintaining strategic working relationships with the practice and division leadership (working through specific issues, committee meetings, monthly updates, etc.). * Assumes a lead role for innovation, knowledge sharing and leading best practice identification. * Manages coding education for practice management and practice/division staff. * Contributes to the development of strategic direction for Coding Operations. * Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement". * Must be willing to be present within physician practices daily to include minimal overnight travel. EDUCATION: * Bachelor's Degree preferred. * Must be a Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator) through AHIMA (American Health Information Management Association) or AAPCs (American Academy of Professional Coders) Certified Professional Coder (CPC) credential or Certified Professional Coder - Hospital (CPC-H) or Certified Risk Adjustment Coder (CRC) EXPERIENCE: * Experience with Cerner and eClinicalWorks (eCW) is strongly preferred. * Minimum 7 years professional fee coding and revenue cycle operations experience strongly preferred. * Minimum 5 years health care management/leadership experience required. * Experience leading large organizations preferred. Benefits HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Regional Coding Operations Manager WFH where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare's graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcares commitment to the care and improvement of human life. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Regional Coding Operations Manager WFH opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.$58k-70k yearly est. 52d agoRegional Manager, Value-Based Programs - REMOTE
Molina Healthcare
Columbus, OH jobs
The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs. **KNOWLEDGE/SKILLS/ABILITIES** + Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. + Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. + Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts. + Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. + Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. + Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. + Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience **Required Experience** + 4+ years managed care experience + Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results + Proven ability to innovate and manage complex processes across multiple functional areas + Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships + Excellent presentation and communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$78k-129.6k yearly 46d agoRegional Manager, Value-Based Programs - REMOTE
Molina Healthcare
Cleveland, OH jobs
The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs. **KNOWLEDGE/SKILLS/ABILITIES** + Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. + Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. + Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts. + Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. + Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. + Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. + Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience **Required Experience** + 4+ years managed care experience + Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results + Proven ability to innovate and manage complex processes across multiple functional areas + Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships + Excellent presentation and communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$78k-129.6k yearly 46d agoRegional Manager, Value-Based Programs - REMOTE
Molina Healthcare
Akron, OH jobs
The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs. **KNOWLEDGE/SKILLS/ABILITIES** + Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. + Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. + Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts. + Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. + Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. + Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. + Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience **Required Experience** + 4+ years managed care experience + Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results + Proven ability to innovate and manage complex processes across multiple functional areas + Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships + Excellent presentation and communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$78k-129.6k yearly 46d agoRegional Manager, Value-Based Programs - REMOTE
Molina Healthcare
Cincinnati, OH jobs
The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs. **KNOWLEDGE/SKILLS/ABILITIES** + Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. + Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. + Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts. + Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. + Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. + Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. + Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience **Required Experience** + 4+ years managed care experience + Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results + Proven ability to innovate and manage complex processes across multiple functional areas + Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships + Excellent presentation and communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$78k-129.6k yearly 46d agoRegional Manager, Value-Based Programs - REMOTE
Molina Healthcare
Dayton, OH jobs
The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs. **KNOWLEDGE/SKILLS/ABILITIES** + Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. + Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. + Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts. + Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. + Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. + Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. + Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience **Required Experience** + 4+ years managed care experience + Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results + Proven ability to innovate and manage complex processes across multiple functional areas + Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships + Excellent presentation and communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$78k-129.6k yearly 46d agoRegional Manager, Value-Based Programs - REMOTE
Molina Healthcare
Houston, TX jobs
The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs. **KNOWLEDGE/SKILLS/ABILITIES** + Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. + Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. + Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts. + Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. + Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. + Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. + Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience **Required Experience** + 4+ years managed care experience + Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results + Proven ability to innovate and manage complex processes across multiple functional areas + Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships + Excellent presentation and communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$78k-129.6k yearly 46d agoRegional Manager, Value-Based Programs - REMOTE
Molina Healthcare
Ohio jobs
The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs. **KNOWLEDGE/SKILLS/ABILITIES** + Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. + Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. + Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts. + Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. + Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. + Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. + Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience **Required Experience** + 4+ years managed care experience + Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results + Proven ability to innovate and manage complex processes across multiple functional areas + Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships + Excellent presentation and communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$78k-129.6k yearly 46d agoVP, AI Enablement
Molina Healthcare
Columbus, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization. **Job Duties** + Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise. + Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment. + Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions. + Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance. + Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences. + Collaborates with IT and business leaders to support internal solution development and vendor partnerships. + Partners with Legal, Compliance, and Information Security to manage risk and data privacy. + Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions. + Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience. + 7 years management/leadership experience. + Proven history of implementing enterprise AI solutions in regulated environments. + Strong cross-functional collaboration and stakeholder management skills. + Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution. + Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring + Familiarity with ethical AI principles and risk management + Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment. + Experience with ambiguity and the ability to drive initiatives from concepts to value realization. \#PJCorp \#LI-AC1 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: $214,132 - $417,557 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$127k-181k yearly est. 49d agoVP, Medical Economics
Molina Healthcare
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.$186.2k-363.1k yearly 39d agoRegional Director for Women and Children
Community Health Systems
Remote
The Regional Director of Women and Children Services shall act as the expert resource, educator, advisor, consultant/mentor, and operations leader to enhance operational excellence and best practice within CHS region(s) assigned. This person will provide consultant/mentorship support to perinatal leadership for assigned regional hospitals in order to support and promote the development of perinatal and neonatal performance and the delivery of a high quality of clinical care consistent with the mission of CHSPSC, LLC. This leader will provide consult services to other entities regarding program development, departmental operations, quality patient care and patient safety. This person may also be asked to provide mentoring to individuals or groups of hospital-based Women and Neonatal Directors/Managers. Essential Duties and Responsibilities include the following, but are not limited to: Evaluating and supporting Women and Children operations in assigned CHS regional hospitals. Assuming responsibility for the consultative development and implementation of policies, procedures, programs and clinical initiatives, while assisting in evaluation of perinatal processes. Serving as mentor and resource person for Women's Health management. Assisting with development of educational material and disseminating to facilities clinical and non-clinical staff, as needed. Working collaboratively with others at Corporate to facilitate and improve Women and Children Services operations, such as working with ED and Surgical Services Regional Directors, Operations Support, Risk Management, and Patient Safety. Developing collaborative relationships with Corporate and hospital personnel, staff and physicians, to ensure a continued focus and improve operations. Researching and developing evidence-based practice standards, best practice criteria and outcomes metrics for CHS hospitals. This role will require travel for various periods of time. This role may require a person to be located in a hospital market for a long period of time and travel to and from the site, as is necessary, to effectively provide guidance on operational improvements. Assist senior leaders at the hospital to improve the leadership capabilities of existing Women's Health Leadership in assigned hospitals using evidence based approaches to leadership development or to assist with selection and on-boarding of new Directors, as needed. Develops effective, data driven action plans that improve departmental operations and metrics while instituting best practice guidelines. ***25%-50% travel*** Qualifications: Excellent technical, management, operational and clinical knowledge of Women and Children's services at all levels of care within an acute healthcare setting. Excellent written and oral communication skills, organizational skills, presentation and computer skills. ∙ Demonstrate experience and the ability to manage multiple groups, interact productively with varying levels of personnel and staff, and provision of program direction and development. Ability to produce and utilize data for project tracking and outcomes achievement. Ability to prioritize projects and resolve conflicting priorities. Ability to develop policies and procedures, performance dashboards and scorecards, assessment forms and other tools related to performance and quality metrics. Demonstrate leadership abilities; flexibility to accept and manage change. Proven ability to interact with all levels of staff and management at hospital, division and corporate level. Identify educational needs and provide educational support, as appropriate for each facility. Reasoning Ability: Ability to define problems, collects data, establish facts, and draw valid conclusions. ∙ Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Computer Skills: To perform this job successfully, an individual should have knowledge of Microsoft Word, Excel, PowerPoint, and Google Suite Certificates and Licenses: Current nursing license required. BLS and NRP upon hire. NCC Certification in Obstetric or Neonatal Nursing preferred Education/Experience: Master's Degree in Nursing, Business, Health Care Administration, or other health/business field, or BSN currently actively enrolled in Master's Degree program in Nursing, Business, Health Care Administration or other health/business related field is preferred. Technical knowledge of perinatal and neonatal nursing, evidence based practice, and the continuum or care. ∙ Training and experience with process improvement, department performance management and optimization, and associated data analytics expertise is required. Knowledge of computer systems, information systems, information management, and data analysis. ∙ Minimum of five years' experience in Women's Health nursing. Minimum of five years experience in management and administration. Experience in leading Perinatal Process Improvement. Preferred experience in multiple healthcare settings or healthcare system with multiple sites of operation. Experience in both community and tertiary care facilities are preferred.$31k-55k yearly est. Auto-Apply 60d+ agoChief Operating Officer (COO) - SSC Sarasota
Community Health Systems
Sarasota, FL jobs
The Chief Operating Officer (COO), Shared Service Center (SSC) Sarasota, FL provides executive leadership to ensure operational efficiency, financial performance, and growth. This role is focused on the newly centralized Pre-Arrival Unit. The COO drives strategic initiatives, manages operational departments, and implements processes to achieve the mission and core values of the SSC. This role is responsible for establishing operational controls, reporting procedures, and people systems that align with the organization's objectives. As the Chief Operating Officer (COO) at Community Health Systems (CHS) - Shared Service Center (SSC) Sarasota, FL, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision insurances, 401k, and a variety of other elective options **Essential Functions** + Provides day-to-day leadership and management of operational departments, ensuring alignment with the SSC's mission, values, and strategic goals. This includes direct leadership over the Centralized Pre-Arrival Unit. + Drives the SSC to meet and exceed key performance indicators (KPIs), such as operational metrics, Net Revenue, Denials Rate, EBITDA, and Positive Cash Flow. + Develops, implements, and monitors operational infrastructure, including systems, processes, and personnel, to accommodate growth objectives and maintain high service standards. + Ensures the measurement and effectiveness of internal and external processes, providing timely, accurate, and comprehensive reports on the SSC's operational performance. + Leads the development, communication, and execution of growth strategies, fostering a results-oriented and accountable environment within the SSC. + Collaborates with the management team to establish plans for operational infrastructure, ensuring continuous improvement in efficiency and effectiveness. + Motivates, mentors, and leads a high-performing management team, focusing on attracting, recruiting, and retaining talent to support career development and succession planning. + Acts as a key liaison between the SSC, other corporate functions, and external partners to enhance collaboration, service delivery, and operational outcomes. Requires ability to engage in high-level, fast-paced dialogue with hospital C-suite members. + Performs other duties as assigned. + Maintains regular and reliable attendance. + Complies with all policies and standards. + **This is a fully remote opportunity. Some travel will be required.** **Qualifications** + Bachelor's Degree in Health Administration, Business Administration, or a related field required + Master's Degree in Health Administration (MHA), Business Administration (MBA), or a related field preferred + More than 10 years of experience in operations management, with at least five (5) years in a senior leadership role required + 8-10 years Prior experience in a shared services environment preferred + Patient Access / Pre-Arrival Unit (PAU) experience, including oversight of scheduling and insurance verification for at least 2 years strongly preferred **Knowledge, Skills and Abilities** + Strong understanding of shared services operations, healthcare regulations, and performance improvement methodologies. + Ideal candidate has COO experience from a 150+ bed hospital with a PAU under their purview. + Proven strategic planning, project management, and analytical skills, with a focus on operational efficiency and growth. + Excellent communication, leadership, and interpersonal skills, with the ability to engage and influence internal teams and external stakeholders. + Proficiency in operational management software, data analysis tools, and Google Suite. + Strong financial acumen, with experience managing budgets and optimizing resource utilization. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. Equal Employment Opportunity This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.$85k-109k yearly est. 18d agoVP, Medical Economics
Molina Healthcare
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 39d agoVP, Medical Economics
Molina Healthcare
Cincinnati, 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 39d agoVP, Medical Economics
Molina Healthcare
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 39d agoChief Operating Officer (COO) - SSC Sarasota
Community Health Systems
Remote
The Chief Operations Officer (COO), Shared Service Center (SSC) Sarasota, FL provides executive leadership to ensure operational efficiency, financial performance, and growth. This role is focused on the newly centralized Pre-Arrival Unit. The COO drives strategic initiatives, manages operational departments, and implements processes to achieve the mission and core values of the SSC. This role is responsible for establishing operational controls, reporting procedures, and people systems that align with the organization's objectives. As the Chief Operations Officer (COO) at Community Health Systems (CHS) - Shared Service Center (SSC) Sarasota, FL, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision insurances, 401k, and a variety of other elective options Essential Functions Provides day-to-day leadership and management of operational departments, ensuring alignment with the SSC's mission, values, and strategic goals. This includes direct leadership over the Centralized Pre-Arrival Unit. Drives the SSC to meet and exceed key performance indicators (KPIs), such as operational metrics, Net Revenue, Denials Rate, EBITDA, and Positive Cash Flow. Develops, implements, and monitors operational infrastructure, including systems, processes, and personnel, to accommodate growth objectives and maintain high service standards. Ensures the measurement and effectiveness of internal and external processes, providing timely, accurate, and comprehensive reports on the SSC's operational performance. Leads the development, communication, and execution of growth strategies, fostering a results-oriented and accountable environment within the SSC. Collaborates with the management team to establish plans for operational infrastructure, ensuring continuous improvement in efficiency and effectiveness. Motivates, mentors, and leads a high-performing management team, focusing on attracting, recruiting, and retaining talent to support career development and succession planning. Acts as a key liaison between the SSC, other corporate functions, and external partners to enhance collaboration, service delivery, and operational outcomes. Requires ability to engage in high-level, fast-paced dialogue with hospital C-suite members. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. This is a fully remote opportunity. Some travel will be required. Qualifications Bachelor's Degree in Health Administration, Business Administration, or a related field required Master's Degree in Health Administration (MHA), Business Administration (MBA), or a related field preferred More than 10 years of experience in operations management, with at least five (5) years in a senior leadership role required 8-10 years Prior experience in a shared services environment preferred Patient Access / Pre-Arrival Unit (PAU) experience, including oversight of scheduling and insurance verification for at least 2 years strongly preferred Knowledge, Skills and Abilities Strong understanding of shared services operations, healthcare regulations, and performance improvement methodologies. Ideal candidate has COO experience from a 150+ bed hospital with a PAU under their purview. Proven strategic planning, project management, and analytical skills, with a focus on operational efficiency and growth. Excellent communication, leadership, and interpersonal skills, with the ability to engage and influence internal teams and external stakeholders. Proficiency in operational management software, data analysis tools, and Google Suite. Strong financial acumen, with experience managing budgets and optimizing resource utilization. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.$114k-171k yearly est. Auto-Apply 19d agoVP, Medical Economics
Molina Healthcare
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.$186.2k-363.1k yearly 39d agoVP, AI Enablement
Molina Healthcare
Akron, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization. **Job Duties** + Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise. + Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment. + Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions. + Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance. + Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences. + Collaborates with IT and business leaders to support internal solution development and vendor partnerships. + Partners with Legal, Compliance, and Information Security to manage risk and data privacy. + Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions. + Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience. + 7 years management/leadership experience. + Proven history of implementing enterprise AI solutions in regulated environments. + Strong cross-functional collaboration and stakeholder management skills. + Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution. + Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring + Familiarity with ethical AI principles and risk management + Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment. + Experience with ambiguity and the ability to drive initiatives from concepts to value realization. \#PJCorp \#LI-AC1 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: $214,132 - $417,557 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$128k-180k yearly est. 49d agoVP, AI Enablement
Molina Healthcare
Dayton, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization. **Job Duties** + Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise. + Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment. + Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions. + Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance. + Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences. + Collaborates with IT and business leaders to support internal solution development and vendor partnerships. + Partners with Legal, Compliance, and Information Security to manage risk and data privacy. + Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions. + Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience. + 7 years management/leadership experience. + Proven history of implementing enterprise AI solutions in regulated environments. + Strong cross-functional collaboration and stakeholder management skills. + Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution. + Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring + Familiarity with ethical AI principles and risk management + Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment. + Experience with ambiguity and the ability to drive initiatives from concepts to value realization. \#PJCorp \#LI-AC1 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: $214,132 - $417,557 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$127k-181k yearly est. 49d agoVP, AI Enablement
Molina Healthcare
Ohio jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization. **Job Duties** + Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise. + Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment. + Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions. + Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance. + Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences. + Collaborates with IT and business leaders to support internal solution development and vendor partnerships. + Partners with Legal, Compliance, and Information Security to manage risk and data privacy. + Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions. + Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience. + 7 years management/leadership experience. + Proven history of implementing enterprise AI solutions in regulated environments. + Strong cross-functional collaboration and stakeholder management skills. + Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution. + Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring + Familiarity with ethical AI principles and risk management + Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment. + Experience with ambiguity and the ability to drive initiatives from concepts to value realization. \#PJCorp \#LI-AC1 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: $214,132 - $417,557 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$127k-179k yearly est. 49d ago
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