VP, Medical Economics
Columbus, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
**Essential Job Duties**
- Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
- Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
- Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
- Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
- Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
- Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
- Informs and supports regular forecasting activities of the enterprise.
- Propagates best medical economics/analysis/SAI development practices across the enterprise.
- Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
- Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
**Required Qualifications**
- At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
- Extensive experience in a leadership position in health care economics, preferably with complex organizations.
- Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
- Demonstrated ability to work with sophisticated analytic tools and datasets.
- Demonstrated ability to convert observations into actions/interventions to improve financial performance.
- Advanced understanding of Medicaid and Medicare programs or other health care plans.
- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
- Advanced proficiency with retrieving specified information from data sources.
- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
- Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
- Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
- Advanced understanding of value-based risk arrangements
- Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
- Advanced problem-solving skills.
- Strong critical-thinking and attention to detail.
- Excellent verbal and written communication skills.
- Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
**Preferred Qualifications**
-Experience in complex managed care.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, AI Enablement
Columbus, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
**Job Duties**
+ Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
+ Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
+ Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
+ Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
+ Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
+ Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
+ Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
+ Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
+ Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
+ 7 years management/leadership experience.
+ Proven history of implementing enterprise AI solutions in regulated environments.
+ Strong cross-functional collaboration and stakeholder management skills.
+ Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
+ Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
+ Familiarity with ethical AI principles and risk management
+ Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
+ Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
\#PJCorp
\#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, AI Enablement
Columbus, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
Job Duties
* Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
* Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
* Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
* Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
* Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
* Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
* Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
* Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
* Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
Job Qualifications
REQUIRED QUALIFICATIONS:
* At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
* 7 years management/leadership experience.
* Proven history of implementing enterprise AI solutions in regulated environments.
* Strong cross-functional collaboration and stakeholder management skills.
* Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
* Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
* Familiarity with ethical AI principles and risk management
* Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
* Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
#PJCorp
#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
VP, Medical Economics
Cleveland, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
**Essential Job Duties**
- Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
- Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
- Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
- Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
- Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
- Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
- Informs and supports regular forecasting activities of the enterprise.
- Propagates best medical economics/analysis/SAI development practices across the enterprise.
- Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
- Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
**Required Qualifications**
- At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
- Extensive experience in a leadership position in health care economics, preferably with complex organizations.
- Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
- Demonstrated ability to work with sophisticated analytic tools and datasets.
- Demonstrated ability to convert observations into actions/interventions to improve financial performance.
- Advanced understanding of Medicaid and Medicare programs or other health care plans.
- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
- Advanced proficiency with retrieving specified information from data sources.
- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
- Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
- Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
- Advanced understanding of value-based risk arrangements
- Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
- Advanced problem-solving skills.
- Strong critical-thinking and attention to detail.
- Excellent verbal and written communication skills.
- Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
**Preferred Qualifications**
-Experience in complex managed care.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, Medical Economics
Cleveland, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
Essential Job Duties
* Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
* Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
* Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
* Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
* Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
* Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
* Informs and supports regular forecasting activities of the enterprise.
* Propagates best medical economics/analysis/SAI development practices across the enterprise.
* Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
* Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
Required Qualifications
* At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
* At least 7 years management/leadership experience.
* Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
* Extensive experience in a leadership position in health care economics, preferably with complex organizations.
* Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
* Demonstrated ability to work with sophisticated analytic tools and datasets.
* Demonstrated ability to convert observations into actions/interventions to improve financial performance.
* Advanced understanding of Medicaid and Medicare programs or other health care plans.
* Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
* Advanced proficiency with retrieving specified information from data sources.
* Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
* Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
* Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
* Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
* Advanced understanding of value-based risk arrangements
* Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
* Advanced problem-solving skills.
* Strong critical-thinking and attention to detail.
* Excellent verbal and written communication skills.
* Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
Preferred Qualifications
* Experience in complex managed care.
* Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
VP, Medical Economics
Dayton, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
**Essential Job Duties**
- Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
- Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
- Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
- Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
- Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
- Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
- Informs and supports regular forecasting activities of the enterprise.
- Propagates best medical economics/analysis/SAI development practices across the enterprise.
- Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
- Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
**Required Qualifications**
- At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
- Extensive experience in a leadership position in health care economics, preferably with complex organizations.
- Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
- Demonstrated ability to work with sophisticated analytic tools and datasets.
- Demonstrated ability to convert observations into actions/interventions to improve financial performance.
- Advanced understanding of Medicaid and Medicare programs or other health care plans.
- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
- Advanced proficiency with retrieving specified information from data sources.
- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
- Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
- Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
- Advanced understanding of value-based risk arrangements
- Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
- Advanced problem-solving skills.
- Strong critical-thinking and attention to detail.
- Excellent verbal and written communication skills.
- Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
**Preferred Qualifications**
-Experience in complex managed care.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, Medical Economics
Akron, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
**Essential Job Duties**
- Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
- Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
- Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
- Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
- Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
- Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
- Informs and supports regular forecasting activities of the enterprise.
- Propagates best medical economics/analysis/SAI development practices across the enterprise.
- Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
- Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
**Required Qualifications**
- At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
- Extensive experience in a leadership position in health care economics, preferably with complex organizations.
- Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
- Demonstrated ability to work with sophisticated analytic tools and datasets.
- Demonstrated ability to convert observations into actions/interventions to improve financial performance.
- Advanced understanding of Medicaid and Medicare programs or other health care plans.
- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
- Advanced proficiency with retrieving specified information from data sources.
- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
- Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
- Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
- Advanced understanding of value-based risk arrangements
- Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
- Advanced problem-solving skills.
- Strong critical-thinking and attention to detail.
- Excellent verbal and written communication skills.
- Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
**Preferred Qualifications**
-Experience in complex managed care.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, Medical Economics
Cincinnati, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
**Essential Job Duties**
- Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
- Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
- Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
- Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
- Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
- Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
- Informs and supports regular forecasting activities of the enterprise.
- Propagates best medical economics/analysis/SAI development practices across the enterprise.
- Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
- Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
**Required Qualifications**
- At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
- Extensive experience in a leadership position in health care economics, preferably with complex organizations.
- Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
- Demonstrated ability to work with sophisticated analytic tools and datasets.
- Demonstrated ability to convert observations into actions/interventions to improve financial performance.
- Advanced understanding of Medicaid and Medicare programs or other health care plans.
- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
- Advanced proficiency with retrieving specified information from data sources.
- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
- Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
- Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
- Advanced understanding of value-based risk arrangements
- Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
- Advanced problem-solving skills.
- Strong critical-thinking and attention to detail.
- Excellent verbal and written communication skills.
- Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
**Preferred Qualifications**
-Experience in complex managed care.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, Medical Economics
Akron, OH jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
Essential Job Duties
* Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
* Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
* Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
* Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
* Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
* Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
* Informs and supports regular forecasting activities of the enterprise.
* Propagates best medical economics/analysis/SAI development practices across the enterprise.
* Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
* Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
Required Qualifications
* At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
* At least 7 years management/leadership experience.
* Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
* Extensive experience in a leadership position in health care economics, preferably with complex organizations.
* Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
* Demonstrated ability to work with sophisticated analytic tools and datasets.
* Demonstrated ability to convert observations into actions/interventions to improve financial performance.
* Advanced understanding of Medicaid and Medicare programs or other health care plans.
* Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
* Advanced proficiency with retrieving specified information from data sources.
* Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
* Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
* Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
* Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
* Advanced understanding of value-based risk arrangements
* Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
* Advanced problem-solving skills.
* Strong critical-thinking and attention to detail.
* Excellent verbal and written communication skills.
* Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
Preferred Qualifications
* Experience in complex managed care.
* Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
VP, Medical Economics
Ohio jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
**Essential Job Duties**
- Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
- Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
- Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
- Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
- Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
- Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
- Informs and supports regular forecasting activities of the enterprise.
- Propagates best medical economics/analysis/SAI development practices across the enterprise.
- Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
- Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
**Required Qualifications**
- At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
- At least 7 years management/leadership experience.
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
- Extensive experience in a leadership position in health care economics, preferably with complex organizations.
- Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
- Demonstrated ability to work with sophisticated analytic tools and datasets.
- Demonstrated ability to convert observations into actions/interventions to improve financial performance.
- Advanced understanding of Medicaid and Medicare programs or other health care plans.
- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
- Advanced proficiency with retrieving specified information from data sources.
- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
- Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
- Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
- Advanced understanding of value-based risk arrangements
- Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
- Advanced problem-solving skills.
- Strong critical-thinking and attention to detail.
- Excellent verbal and written communication skills.
- Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
**Preferred Qualifications**
-Experience in complex managed care.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, Medical Economics
Ohio jobs
Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.
Essential Job Duties
* Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends.
* Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
* Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals.
* Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy.
* Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery.
* Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required.
* Informs and supports regular forecasting activities of the enterprise.
* Propagates best medical economics/analysis/SAI development practices across the enterprise.
* Leads enterprise information management (EIM) team to build out data analytic tools and capabilities.
* Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc.
Required Qualifications
* At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience.
* At least 7 years management/leadership experience.
* Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
* Extensive experience in a leadership position in health care economics, preferably with complex organizations.
* Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization
* Demonstrated ability to work with sophisticated analytic tools and datasets.
* Demonstrated ability to convert observations into actions/interventions to improve financial performance.
* Advanced understanding of Medicaid and Medicare programs or other health care plans.
* Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
* Advanced proficiency with retrieving specified information from data sources.
* Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
* Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
* Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
* Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
* Advanced understanding of value-based risk arrangements
* Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
* Advanced problem-solving skills.
* Strong critical-thinking and attention to detail.
* Excellent verbal and written communication skills.
* Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
Preferred Qualifications
* Experience in complex managed care.
* Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Chief Operating Officer (COO) - SSC Sarasota
Sarasota, FL jobs
The Chief Operating Officer (COO), Shared Service Center (SSC) Sarasota, FL provides executive leadership to ensure operational efficiency, financial performance, and growth. This role is focused on the newly centralized Pre-Arrival Unit. The COO drives strategic initiatives, manages operational departments, and implements processes to achieve the mission and core values of the SSC. This role is responsible for establishing operational controls, reporting procedures, and people systems that align with the organization's objectives.
As the Chief Operating Officer (COO) at Community Health Systems (CHS) - Shared Service Center (SSC) Sarasota, FL, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision insurances, 401k, and a variety of other elective options
**Essential Functions**
+ Provides day-to-day leadership and management of operational departments, ensuring alignment with the SSC's mission, values, and strategic goals. This includes direct leadership over the Centralized Pre-Arrival Unit.
+ Drives the SSC to meet and exceed key performance indicators (KPIs), such as operational metrics, Net Revenue, Denials Rate, EBITDA, and Positive Cash Flow.
+ Develops, implements, and monitors operational infrastructure, including systems, processes, and personnel, to accommodate growth objectives and maintain high service standards.
+ Ensures the measurement and effectiveness of internal and external processes, providing timely, accurate, and comprehensive reports on the SSC's operational performance.
+ Leads the development, communication, and execution of growth strategies, fostering a results-oriented and accountable environment within the SSC.
+ Collaborates with the management team to establish plans for operational infrastructure, ensuring continuous improvement in efficiency and effectiveness.
+ Motivates, mentors, and leads a high-performing management team, focusing on attracting, recruiting, and retaining talent to support career development and succession planning.
+ Acts as a key liaison between the SSC, other corporate functions, and external partners to enhance collaboration, service delivery, and operational outcomes. Requires ability to engage in high-level, fast-paced dialogue with hospital C-suite members.
+ Performs other duties as assigned.
+ Maintains regular and reliable attendance.
+ Complies with all policies and standards.
+ **This is a fully remote opportunity. Some travel will be required.**
**Qualifications**
+ Bachelor's Degree in Health Administration, Business Administration, or a related field required
+ Master's Degree in Health Administration (MHA), Business Administration (MBA), or a related field preferred
+ More than 10 years of experience in operations management, with at least five (5) years in a senior leadership role required
+ 8-10 years Prior experience in a shared services environment preferred
+ Patient Access / Pre-Arrival Unit (PAU) experience, including oversight of scheduling and insurance verification for at least 2 years strongly preferred
**Knowledge, Skills and Abilities**
+ Strong understanding of shared services operations, healthcare regulations, and performance improvement methodologies.
+ Ideal candidate has COO experience from a 150+ bed hospital with a PAU under their purview.
+ Proven strategic planning, project management, and analytical skills, with a focus on operational efficiency and growth.
+ Excellent communication, leadership, and interpersonal skills, with the ability to engage and influence internal teams and external stakeholders.
+ Proficiency in operational management software, data analysis tools, and Google Suite.
+ Strong financial acumen, with experience managing budgets and optimizing resource utilization.
We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.
Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
Equal Employment Opportunity
This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.
VP, AI Enablement
Cleveland, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
**Job Duties**
+ Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
+ Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
+ Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
+ Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
+ Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
+ Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
+ Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
+ Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
+ Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
+ 7 years management/leadership experience.
+ Proven history of implementing enterprise AI solutions in regulated environments.
+ Strong cross-functional collaboration and stakeholder management skills.
+ Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
+ Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
+ Familiarity with ethical AI principles and risk management
+ Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
+ Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
\#PJCorp
\#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, AI Enablement
Cleveland, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
Job Duties
* Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
* Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
* Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
* Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
* Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
* Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
* Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
* Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
* Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
Job Qualifications
REQUIRED QUALIFICATIONS:
* At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
* 7 years management/leadership experience.
* Proven history of implementing enterprise AI solutions in regulated environments.
* Strong cross-functional collaboration and stakeholder management skills.
* Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
* Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
* Familiarity with ethical AI principles and risk management
* Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
* Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
#PJCorp
#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
Chief Operating Officer (COO) - SSC Sarasota
Remote
The Chief Operations Officer (COO), Shared Service Center (SSC) Sarasota, FL provides executive leadership to ensure operational efficiency, financial performance, and growth. This role is focused on the newly centralized Pre-Arrival Unit. The COO drives strategic initiatives, manages operational departments, and implements processes to achieve the mission and core values of the SSC. This role is responsible for establishing operational controls, reporting procedures, and people systems that align with the organization's objectives.
As the Chief Operations Officer (COO) at Community Health Systems (CHS) - Shared Service Center (SSC) Sarasota, FL, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision insurances, 401k, and a variety of other elective options
Essential Functions
Provides day-to-day leadership and management of operational departments, ensuring alignment with the SSC's mission, values, and strategic goals. This includes direct leadership over the Centralized Pre-Arrival Unit.
Drives the SSC to meet and exceed key performance indicators (KPIs), such as operational metrics, Net Revenue, Denials Rate, EBITDA, and Positive Cash Flow.
Develops, implements, and monitors operational infrastructure, including systems, processes, and personnel, to accommodate growth objectives and maintain high service standards.
Ensures the measurement and effectiveness of internal and external processes, providing timely, accurate, and comprehensive reports on the SSC's operational performance.
Leads the development, communication, and execution of growth strategies, fostering a results-oriented and accountable environment within the SSC.
Collaborates with the management team to establish plans for operational infrastructure, ensuring continuous improvement in efficiency and effectiveness.
Motivates, mentors, and leads a high-performing management team, focusing on attracting, recruiting, and retaining talent to support career development and succession planning.
Acts as a key liaison between the SSC, other corporate functions, and external partners to enhance collaboration, service delivery, and operational outcomes. Requires ability to engage in high-level, fast-paced dialogue with hospital C-suite members.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.
This is a fully remote opportunity. Some travel will be required.
Qualifications
Bachelor's Degree in Health Administration, Business Administration, or a related field required
Master's Degree in Health Administration (MHA), Business Administration (MBA), or a related field preferred
More than 10 years of experience in operations management, with at least five (5) years in a senior leadership role required
8-10 years Prior experience in a shared services environment preferred
Patient Access / Pre-Arrival Unit (PAU) experience, including oversight of scheduling and insurance verification for at least 2 years strongly preferred
Knowledge, Skills and Abilities
Strong understanding of shared services operations, healthcare regulations, and performance improvement methodologies.
Ideal candidate has COO experience from a 150+ bed hospital with a PAU under their purview.
Proven strategic planning, project management, and analytical skills, with a focus on operational efficiency and growth.
Excellent communication, leadership, and interpersonal skills, with the ability to engage and influence internal teams and external stakeholders.
Proficiency in operational management software, data analysis tools, and Google Suite.
Strong financial acumen, with experience managing budgets and optimizing resource utilization.
We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.
Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
Auto-ApplyVP, AI Enablement
Akron, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
**Job Duties**
+ Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
+ Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
+ Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
+ Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
+ Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
+ Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
+ Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
+ Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
+ Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
+ 7 years management/leadership experience.
+ Proven history of implementing enterprise AI solutions in regulated environments.
+ Strong cross-functional collaboration and stakeholder management skills.
+ Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
+ Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
+ Familiarity with ethical AI principles and risk management
+ Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
+ Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
\#PJCorp
\#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, AI Enablement
Cincinnati, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
**Job Duties**
+ Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
+ Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
+ Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
+ Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
+ Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
+ Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
+ Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
+ Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
+ Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
+ 7 years management/leadership experience.
+ Proven history of implementing enterprise AI solutions in regulated environments.
+ Strong cross-functional collaboration and stakeholder management skills.
+ Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
+ Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
+ Familiarity with ethical AI principles and risk management
+ Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
+ Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
\#PJCorp
\#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, AI Enablement
Akron, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
Job Duties
* Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
* Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
* Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
* Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
* Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
* Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
* Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
* Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
* Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
Job Qualifications
REQUIRED QUALIFICATIONS:
* At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
* 7 years management/leadership experience.
* Proven history of implementing enterprise AI solutions in regulated environments.
* Strong cross-functional collaboration and stakeholder management skills.
* Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
* Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
* Familiarity with ethical AI principles and risk management
* Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
* Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
#PJCorp
#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
VP, AI Enablement
Dayton, OH jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
**Job Duties**
+ Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
+ Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
+ Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
+ Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
+ Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
+ Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
+ Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
+ Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
+ Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
+ 7 years management/leadership experience.
+ Proven history of implementing enterprise AI solutions in regulated environments.
+ Strong cross-functional collaboration and stakeholder management skills.
+ Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
+ Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
+ Familiarity with ethical AI principles and risk management
+ Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
+ Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
\#PJCorp
\#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
VP, AI Enablement
Ohio jobs
Leads the development and activation of Molina's Artificial Intelligence (AI) Center of Excellence (CoE), responsible for enterprise-wide AI strategy, including identification, evaluation, deployment and value realization of AI solutions. In partnership with technology and business leaders, define what can be achieved through AI and scale high-performing solutions across the organization.
**Job Duties**
+ Leads Molina's AI Center of Excellence, including developing and driving Molina's AI strategy and roadmap, including establishing a governance framework, guardrails for compliance, policies, processes, and best practices for responsible use and adoption of AI tools, processes and/or technological enhancements across the enterprise.
+ Develops robust pipeline of AI solutions through intake and evaluation of use cases for deployment.
+ Responsible for the ideation, solution evaluation, recommendations and portfolio rationalization/prioritization of GenAI, AgenticAI and Artificial General Intelligence (AGI) solutions.
+ Leads implementation planning and change management for AI solutions, including establishing mechanisms and tools to track portfolio performance.
+ Responsible for value realization post-AI solution deployments, from targeted productivity gains to end-to-end reimagining of workflows and managed care experiences.
+ Collaborates with IT and business leaders to support internal solution development and vendor partnerships.
+ Partners with Legal, Compliance, and Information Security to manage risk and data privacy.
+ Manages AI COE team, supporting portfolio pipelining, development and implementation of AI solutions.
+ Oversight of AI champion network, supporting adoption and sustainability of AI solutions enterprise-wide.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ At least 12 years of experience in managed care, including strategy, enterprise transformation, digital innovation, technology solutions, or equivalent combination of relevant education and experience.
+ 7 years management/leadership experience.
+ Proven history of implementing enterprise AI solutions in regulated environments.
+ Strong cross-functional collaboration and stakeholder management skills.
+ Experience with budget planning, compliance frameworks, and performance metrics. Record of leading business transformations, from strategy through execution.
+ Conceptual understanding of the AI/ML technologies and solution development lifecycle, from ideation through deployment and monitoring
+ Familiarity with ethical AI principles and risk management
+ Demonstrated ability to lead, mentor, and develop high-performing teams in a matrixed business environment.
+ Experience with ambiguity and the ability to drive initiatives from concepts to value realization.
\#PJCorp
\#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $214,132 - $417,557 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.