COO, Health Plan (Ohio)

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    "ExternalDescriptionStr": "<p><strong>Job Description</strong>&nbsp;<br><strong>Job Summary</strong>&nbsp;<br>\n Responsible for the overall direction and administration of the operational departments, programs and services provided by the health plan. Responsibilities include: implementing programs that are in alignment with Molina's strategic plan and operating plan; providing day-to-day leadership and management of the health plan operations that mirrors the company's mission, vision, and core values; and&nbsp;<br>\n ensure the efficient and compliant operations of the health plan. Specific areas of responsibility can include: Provider Network Management (Contracting, Provider Services, Operations), Member Services/Appeals &amp; Grievances, Community Engagement, Project Management and Remote Office leadership and guidance.&nbsp;<br>\n &nbsp;</p>\n<p><strong>Preferred Work Location</strong> - Ohio</p>\n<p><strong>Knowledge/Skills/Abilities</strong>&nbsp;<br>\n Duties and Responsibilities (List all essential duties and responsibilities in order of importance)&nbsp;<br>\n • Serve as Health Plan point of contact&nbsp;<br>\n • Ensure all Shared Service areas and Functions understanding priorities and issues for the Health Plan.&nbsp;<br>\n • Collaborate with Shared Services to ensure they understand and are fulfilling Health Plan requests and commitments&nbsp;<br>\n • Formulate and implement business plans, tactics and strategies to provide for the efficient, effective and compliant operations to meet short-term objectives/obligations and ensure long term growth and success.&nbsp;<br>\n • Develop and implement adequate measures to meet the operational needs of the company, to efficiently utilize its resources, and to maintain an effective system of operational processes &amp; outcome measurement.&nbsp;<br>\n • Create new policies and amend existing policies to improve operations as needed. Present reports and recommendations on the operations of the state plan and propose changes to major policies.&nbsp;<br>\n • Identify and drive new initiatives to optimize systems' performance and leverage functionality to:&nbsp;<br>\n • o Increase claims payment accuracy and auto-adjudication&nbsp;<br>\n • o Increase members and provider satisfaction&nbsp;<br>\n • o Identify and implement cost savings initiatives in contracting, operations and employee productivity&nbsp;<br>\n • o Avoid work-arounds and unplanned re-work.&nbsp;<br>\n • Ensure the overall level of quality for operational and contractual obligations meet or exceed appropriate standards.&nbsp;<br>\n • Provide personal leadership that encourages employee productivity and responsiveness to the needs of the current and prospective members, providers and regulatory agencies/staff.&nbsp;<br>\n • Ensure programs are established to comply with all relevant federal, state and local regulations.&nbsp;<br><br>\n State Plan / Department Specific Duties and Responsibilities (List all essential duties other than those listed above in order of importance)&nbsp;<br>\n • Overall management of various departments/functions in multiple office locations which could include:&nbsp;<br>\n o Network Management and Operations&nbsp;<br>\n o Health Plan Operations&nbsp;<br>\n o Other Functional Areas as Needed&nbsp;<br>\n • Other duties:&nbsp;<br>\n o Project Management&nbsp;<br>\n o Represent the Health Plan on various committees and work groups within the Shared Services Team&nbsp;<br>\n o Other duties as requested&nbsp;<br>\n o&nbsp;<br>\n o Operational and Communication work groups&nbsp;<br>\n o&nbsp;<br>\n o Project Management&nbsp;<br>\n o Represent Health Plan on MHI Committees or Operational workgroups (e.g., VPs of Network Management monthly meeting, MHI Ops Quarterly meeting with Health Plan, etc.)&nbsp;<br>\n o Other functional areas as needed.&nbsp;<br>\n &nbsp; <strong>Job Qualifications</strong></p>\n<p><br><br><strong>Required Education</strong><br>\n Bachelors' degree in Business, Health Services Master's Degree in Business, Policy, Public Administration or Health Services Administration or related field.<br><strong>Required Experience</strong><br>\n 15-plus year's progressive healthcare experience. Direct experience in the managed care industry; 10+ years of managed care with Medicaid and Medicare managed care plans. Management experience.<br><strong>Preferred Education</strong><br>\n Master's or PhD Degree in public health, social or behavioral services or similar discipline<br><strong>Preferred Experience</strong><br>\n 10+ years in public health, social or behavioral services, or similar field; 3+ years in a direct or matrix leadership position<br><br>\n To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.<br><br>\n Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.</p>",
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