Regional Director jobs at HCA Healthcare - 37 jobs

Regional Coding Operations Manager WFH
HCA Healthcare 4.5
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 AAPC's (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 Healthcare's 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.
$62k-76k yearly est. 60d+ ago

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Regional Manager, Value-Based Programs - REMOTE
Molina Healthcare 4.4
San Antonio, TX jobs
Provides subject matter expertise and leadership for national value-based programs (VBP) activities. Manages and leads the development and implementation of value-based programs/contracts by supporting local markets and the national value-based contracting (VBC) team. Provides support for proposal and counter-proposal development, tracks financial performance of existing VBC programs and contracts, and ensures alignment with local health plan financial forecasts and goals. Accountable for designing and implementing strategies to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new VBC opportunities relevant to local markets and lines of business. **Essential Job Duties** - Collaborates directly with assigned market network leaders to identify providers for value-based contracting (VBC), - Supports local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations, assists with periodic reconciliations and data sharing processes, and supports process for setting annual targets for each value-based arranged in conjunction with national quality and risk adjustment leadership and local health plan resources. - Leverages knowledge of local market/line of business and applicable state/federal requirements to ensure workplans for value-based contracting are sufficient to meet requirements. - Reviews internal dashboard of value-based programs and contracts by state by line of business 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 requests for proposals (RFPs) and financial forecasts. - Ensures internal/external VBC/reporting data and reporting is accurate; ensures local market finance partners have required information to produce accurate accounting for value-based arrangements. - 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. **Required Qualifications** + 4+ years of managed care experience - Medicaid, Medicare, Marketplace. + 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. + Exceptional communication, facilitation, and relationship-building skills. + Strategic thinker with strong problem-solving and decision-making abilities. + Excellent leadership skills, especially the 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 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: $80,168 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-129.6k yearly 4d ago
Regional Manager, Value-Based Programs - REMOTE
Molina Healthcare 4.4
Cleveland, OH jobs
Provides subject matter expertise and leadership for national value-based programs (VBP) activities. Manages and leads the development and implementation of value-based programs/contracts by supporting local markets and the national value-based contracting (VBC) team. Provides support for proposal and counter-proposal development, tracks financial performance of existing VBC programs and contracts, and ensures alignment with local health plan financial forecasts and goals. Accountable for designing and implementing strategies to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new VBC opportunities relevant to local markets and lines of business. **Essential Job Duties** - Collaborates directly with assigned market network leaders to identify providers for value-based contracting (VBC), - Supports local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations, assists with periodic reconciliations and data sharing processes, and supports process for setting annual targets for each value-based arranged in conjunction with national quality and risk adjustment leadership and local health plan resources. - Leverages knowledge of local market/line of business and applicable state/federal requirements to ensure workplans for value-based contracting are sufficient to meet requirements. - Reviews internal dashboard of value-based programs and contracts by state by line of business 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 requests for proposals (RFPs) and financial forecasts. - Ensures internal/external VBC/reporting data and reporting is accurate; ensures local market finance partners have required information to produce accurate accounting for value-based arrangements. - 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. **Required Qualifications** + 4+ years of managed care experience - Medicaid, Medicare, Marketplace. + 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. + Exceptional communication, facilitation, and relationship-building skills. + Strategic thinker with strong problem-solving and decision-making abilities. + Excellent leadership skills, especially the 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 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: $80,168 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-129.6k yearly 4d ago
Regional Manager, Value-Based Programs - REMOTE
Molina Healthcare 4.4
Milwaukee, WI jobs
Provides subject matter expertise and leadership for national value-based programs (VBP) activities. Manages and leads the development and implementation of value-based programs/contracts by supporting local markets and the national value-based contracting (VBC) team. Provides support for proposal and counter-proposal development, tracks financial performance of existing VBC programs and contracts, and ensures alignment with local health plan financial forecasts and goals. Accountable for designing and implementing strategies to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new VBC opportunities relevant to local markets and lines of business. **Essential Job Duties** - Collaborates directly with assigned market network leaders to identify providers for value-based contracting (VBC), - Supports local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations, assists with periodic reconciliations and data sharing processes, and supports process for setting annual targets for each value-based arranged in conjunction with national quality and risk adjustment leadership and local health plan resources. - Leverages knowledge of local market/line of business and applicable state/federal requirements to ensure workplans for value-based contracting are sufficient to meet requirements. - Reviews internal dashboard of value-based programs and contracts by state by line of business 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 requests for proposals (RFPs) and financial forecasts. - Ensures internal/external VBC/reporting data and reporting is accurate; ensures local market finance partners have required information to produce accurate accounting for value-based arrangements. - 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. **Required Qualifications** + 4+ years of managed care experience - Medicaid, Medicare, Marketplace. + 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. + Exceptional communication, facilitation, and relationship-building skills. + Strategic thinker with strong problem-solving and decision-making abilities. + Excellent leadership skills, especially the 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 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: $80,168 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-129.6k yearly 4d ago
Regional Manager, Value-Based Programs - REMOTE
Molina Healthcare 4.4
Dayton, OH jobs
Provides subject matter expertise and leadership for national value-based programs (VBP) activities. Manages and leads the development and implementation of value-based programs/contracts by supporting local markets and the national value-based contracting (VBC) team. Provides support for proposal and counter-proposal development, tracks financial performance of existing VBC programs and contracts, and ensures alignment with local health plan financial forecasts and goals. Accountable for designing and implementing strategies to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new VBC opportunities relevant to local markets and lines of business. **Essential Job Duties** - Collaborates directly with assigned market network leaders to identify providers for value-based contracting (VBC), - Supports local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations, assists with periodic reconciliations and data sharing processes, and supports process for setting annual targets for each value-based arranged in conjunction with national quality and risk adjustment leadership and local health plan resources. - Leverages knowledge of local market/line of business and applicable state/federal requirements to ensure workplans for value-based contracting are sufficient to meet requirements. - Reviews internal dashboard of value-based programs and contracts by state by line of business 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 requests for proposals (RFPs) and financial forecasts. - Ensures internal/external VBC/reporting data and reporting is accurate; ensures local market finance partners have required information to produce accurate accounting for value-based arrangements. - 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. **Required Qualifications** + 4+ years of managed care experience - Medicaid, Medicare, Marketplace. + 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. + Exceptional communication, facilitation, and relationship-building skills. + Strategic thinker with strong problem-solving and decision-making abilities. + Excellent leadership skills, especially the 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 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: $80,168 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-129.6k yearly 4d ago
Regional CDI Director- Remote
Tenet Healthcare Corporation 4.5
Frisco, TX jobs
Responsible for management of Clinical Documentation Improvement (CDI) program to direct the activities of the CDI operations across multiple hospitals, facilitate modifications to clinical documentation to ensure accurate depiction of the level of clinical services and patient severity through extensive concurrent interaction with client leadership, physicians, nursing staff and other caregivers, case management and medical records coding staff. Responsible for performance improvement for Conifer and Client(s). ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. 1. * Implement and support the strategic vision for assigned Clinical Documentation Improvement (CDI) functions to include: * Direct responses to CDI and trending completion of DRG worksheets via analytical reports. * Act as a resource to CDI leaders in matters relating to published DRG information. * Works with market and national leaders including physician groups to develop systems to facilitate complete documentation for data reporting purposes. * Builds and maintains productive inter/intra departmental and vendor work relationships to optimize operations. * Oversees compliance with government and agency regulations 2. Develops and monitors strategic operating goals, objectives and budget; and reports operational performance, justification and/or corrective action. 3. Develops and manages direct reports; and oversees the development and management of indirect reports. 4. Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, Compliant documentation protocols 5. Other duties as assigned FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense): N/A No. Direct Reports (incl. titles) - 2+ CDI Manager No. Indirect Reports (incl. titles) - 30+ CDI Specialist, CDI Supervisor, CDI Lead To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * CDI Director must display, leadership, teamwork and commitment while performing daily duties * Must demonstrate initiative and discipline in time management and medical record review * Travel may be required to meet the needs of the division * Other duties as assigned based on leadership request(s). * Advanced knowledge of IMedicare Part A and familiar with Medicare Part B * Intermediate knowledge of disease pathophysiology and drug utilization * Intermediate knowledge of MS-DRG classification and reimbursement structures * Critical thinking, problem solving and deductive reasoning skills * Effective written and verbal communication skills * Knowledge of regulatory environment * Excellent organizational skills for initiation and maintenance of efficient work flow * Regular and reliable attendance and time reporting per Conifer Telecommuting program requirements * Capacity to work independently in a virtual office setting or at facility setting if required to travel for assignment. * Understand and communicate documentation strategies * Recognize opportunities for documentation improvement * Formulate clinically, compliant credible queries * Ability to maintain an auditing and monitoring program as a means to measure query process * Ability to apply coding conventions, official guidelines, and Coding Clinic advice to health record documentation * Develop and implement work policy and procedures * Responsible for the CDI program to ensure quality documentation Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Graduate from a Nursing program ADN, BSN prefered, or graduate of Health Information Management RHIT, RHIA preferred. * Current state Registered Nurse license or Certified Coding Speiclaist credential * Preferred: Two (2) years experience with either HIM/Coding or Case Management experience. CERTIFICATES, LICENSES, REGISTRATIONS * Preferred: RN, RHIT, RHIA, and CCS, CDIP, CCDS PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit for extended periods of time * Must be able to efficiently use computer keyboard and mouse to perform CDI functions assignments * Good Visual acuity WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. OTHER * The ideal candidate will have clinical documentation experience in an acute care facility * Must be able to travel nationally as needed Compensation and Benefit Information Compensation * Pay: $118,227 - $177,362 annually. Compensation depends on location, qualifications, and experience. * Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Management time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********
$118.2k-177.4k yearly 14d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare Inc. 4.4
Columbus, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. KNOWLEDGE/SKILLS/ABILITIES * Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. * Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. * Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. * Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. * Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. * Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. * Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. * Coordinate reporting and packaging needs for critical leadership meetings. * Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. * Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. * Communicates a clear strategy with key performance indicators and updates in assigned areas. * Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. * Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. JOB QUALIFICATIONS Required Education Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. Required Experience At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. Preferred Education Master's Degree in a related field Preferred License, Certification, Association RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$58k-106k yearly est. 30d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare 4.4
Columbus, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. + Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. + Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. + Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. + Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. + Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. + Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. + Coordinate reporting and packaging needs for critical leadership meetings. + Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. + Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. + Communicates a clear strategy with key performance indicators and updates in assigned areas. + Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. + Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. **Required Experience** At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. **Preferred Education** Master's Degree in a related field **Preferred License, Certification, Association** RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$58k-106k yearly est. 29d ago
Regional Manager, Value-Based Programs - REMOTE
Molina Healthcare 4.4
Long Beach, CA jobs
Provides subject matter expertise and leadership for national value-based programs (VBP) activities. Manages and leads the development and implementation of value-based programs/contracts by supporting local markets and the national value-based contracting (VBC) team. Provides support for proposal and counter-proposal development, tracks financial performance of existing VBC programs and contracts, and ensures alignment with local health plan financial forecasts and goals. Accountable for designing and implementing strategies to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new VBC opportunities relevant to local markets and lines of business. Essential Job Duties • Collaborates directly with assigned market network leaders to identify providers for value-based contracting (VBC), • Supports local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations, assists with periodic reconciliations and data sharing processes, and supports process for setting annual targets for each value-based arranged in conjunction with national quality and risk adjustment leadership and local health plan resources. • Leverages knowledge of local market/line of business and applicable state/federal requirements to ensure workplans for value-based contracting are sufficient to meet requirements. • Reviews internal dashboard of value-based programs and contracts by state by line of business 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 requests for proposals (RFPs) and financial forecasts. • Ensures internal/external VBC/reporting data and reporting is accurate; ensures local market finance partners have required information to produce accurate accounting for value-based arrangements. • 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. Required Qualifications 4+ years of managed care experience - Medicaid, Medicare, Marketplace. 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. Exceptional communication, facilitation, and relationship-building skills. Strategic thinker with strong problem-solving and decision-making abilities. Excellent leadership skills, especially the 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 Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
$67k-98k yearly est. Auto-Apply 5d ago
Regional Account Manager, Pharmacy Services (Remote)
Molina Healthcare 4.4
Long Beach, CA jobs
Leads and manages team of pharmacy staff responsible to ensure member access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties • Provides oversight of the Pharmacy Benefit Manager (PBM) for designated health plan(s), including tracking of service warranties and performance guarantees. • Provides assistance with pharmacy related health plan and corporate projects. • Supports state health plan functions, goals, and initiatives. • Represents as direct pharmacy contact for state agencies as needed. • Identifies pharmacy related trends and implements process improvement related changes as needed. • Liaises with member and provider service teams for both Molina and the PBM. • Maintains the pharmacy SharePoint and provides feedback and support related to website updates. • Develops both routine and ad hoc pharmacy member and provider communications. • Supports pharmacy leadership in reviewing and updating state specific policies and procedures to ensure compliance with contractual and regulatory requirements. • Provides ad hoc pharmacy related reporting. • Provides subject matter expertise for pharmacy compliance and legislative regulations. • Provides support for corporate pharmacy quality related initiatives. • Provides support for state/Office of Inspector General (OIG) investigations. • Provides support for the state member lock-in program. • Provides support for state specific formulary management. • Provides support for health plan pharmacy encounters. • Manages and resolves urgent issues for health plan(s). e.g. state complaints related to pharmacy. • Supports and completes all pharmacy audits as required (SOX, CMS, internal, network, etc.). • Acts as primary liaison to PBM for health plan(s). • Provides supervision to pharmacy staff, and demonstrates accountability for performance. • Provides coaching for pharmacy staff and helps identify and provide training needs in collaboration with pharmacy leadership. Required Qualifications • At least 7 years of experience in pharmacy, pharmacy managed care or Pharmacy Benefit Manager(PBM), or equivalent combination of relevant education and experience or equivalent experience. • At least 1 year management/leadership experience. • Ability to present ideas and information concisely to varied audiences. • Knowledge of processes and systems necessary to develop and deliver necessary training to departmental staff and internal customers. • Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. • Proficiency in compiling data, creating reports and presenting information. • Ability to meet established deadlines. • Ability to function independently and manage multiple projects. • Excellent verbal and written communication skills. • Microsoft Office suite, and applicable software program(s) proficiency. Preferred Qualifications • Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required), or Doctor of Pharmacy (PharmD) license. If licensed, license must be active and unrestricted in state of practice. • Health plan pharmacy operations experience. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$89k-125k yearly est. Auto-Apply 1d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare Inc. 4.4
Cleveland, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. KNOWLEDGE/SKILLS/ABILITIES * Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. * Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. * Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. * Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. * Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. * Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. * Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. * Coordinate reporting and packaging needs for critical leadership meetings. * Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. * Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. * Communicates a clear strategy with key performance indicators and updates in assigned areas. * Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. * Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. JOB QUALIFICATIONS Required Education Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. Required Experience At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. Preferred Education Master's Degree in a related field Preferred License, Certification, Association RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$59k-110k yearly est. 30d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare 4.4
Cleveland, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. + Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. + Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. + Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. + Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. + Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. + Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. + Coordinate reporting and packaging needs for critical leadership meetings. + Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. + Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. + Communicates a clear strategy with key performance indicators and updates in assigned areas. + Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. + Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. **Required Experience** At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. **Preferred Education** Master's Degree in a related field **Preferred License, Certification, Association** RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$59k-110k yearly est. 29d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare Inc. 4.4
Akron, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. KNOWLEDGE/SKILLS/ABILITIES * Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. * Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. * Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. * Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. * Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. * Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. * Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. * Coordinate reporting and packaging needs for critical leadership meetings. * Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. * Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. * Communicates a clear strategy with key performance indicators and updates in assigned areas. * Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. * Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. JOB QUALIFICATIONS Required Education Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. Required Experience At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. Preferred Education Master's Degree in a related field Preferred License, Certification, Association RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$59k-111k yearly est. 30d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare 4.4
Akron, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. + Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. + Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. + Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. + Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. + Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. + Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. + Coordinate reporting and packaging needs for critical leadership meetings. + Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. + Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. + Communicates a clear strategy with key performance indicators and updates in assigned areas. + Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. + Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. **Required Experience** At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. **Preferred Education** Master's Degree in a related field **Preferred License, Certification, Association** RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$59k-111k yearly est. 29d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare Inc. 4.4
Cincinnati, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. KNOWLEDGE/SKILLS/ABILITIES * Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. * Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. * Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. * Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. * Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. * Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. * Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. * Coordinate reporting and packaging needs for critical leadership meetings. * Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. * Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. * Communicates a clear strategy with key performance indicators and updates in assigned areas. * Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. * Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. JOB QUALIFICATIONS Required Education Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. Required Experience At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. Preferred Education Master's Degree in a related field Preferred License, Certification, Association RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$55k-100k yearly est. 30d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare 4.4
Cincinnati, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. + Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. + Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. + Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. + Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. + Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. + Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. + Coordinate reporting and packaging needs for critical leadership meetings. + Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. + Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. + Communicates a clear strategy with key performance indicators and updates in assigned areas. + Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. + Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. **Required Experience** At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. **Preferred Education** Master's Degree in a related field **Preferred License, Certification, Association** RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$55k-100k yearly est. 29d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare Inc. 4.4
Dayton, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. KNOWLEDGE/SKILLS/ABILITIES * Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. * Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. * Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. * Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. * Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. * Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. * Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. * Coordinate reporting and packaging needs for critical leadership meetings. * Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. * Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. * Communicates a clear strategy with key performance indicators and updates in assigned areas. * Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. * Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. JOB QUALIFICATIONS Required Education Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. Required Experience At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. Preferred Education Master's Degree in a related field Preferred License, Certification, Association RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$56k-102k yearly est. 30d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare 4.4
Dayton, OH jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. + Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. + Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. + Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. + Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. + Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. + Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. + Coordinate reporting and packaging needs for critical leadership meetings. + Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. + Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. + Communicates a clear strategy with key performance indicators and updates in assigned areas. + Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. + Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. **Required Experience** At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. **Preferred Education** Master's Degree in a related field **Preferred License, Certification, Association** RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$56k-102k yearly est. 29d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare Inc. 4.4
Ohio jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. KNOWLEDGE/SKILLS/ABILITIES * Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. * Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. * Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. * Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. * Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. * Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. * Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. * Coordinate reporting and packaging needs for critical leadership meetings. * Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. * Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. * Communicates a clear strategy with key performance indicators and updates in assigned areas. * Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. * Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. JOB QUALIFICATIONS Required Education Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. Required Experience At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. Preferred Education Master's Degree in a related field Preferred License, Certification, Association RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$58k-106k yearly est. 30d ago
Regional Director, Risk & Quality Solutions
Molina Healthcare 4.4
Ohio jobs
Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements. + Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements. + Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership. + Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals. + Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina. + Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance. + Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions. + Coordinate reporting and packaging needs for critical leadership meetings. + Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines. + Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention. + Communicates a clear strategy with key performance indicators and updates in assigned areas. + Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings. + Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience. **Required Experience** At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions. **Preferred Education** Master's Degree in a related field **Preferred License, Certification, Association** RN with Quality Background is preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $227,679 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$58k-106k yearly est. 29d ago