COO, Health Plan (Ohio)

Job Title

Job Title

Job Description

Job Summary: 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 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 & Grievances, Community Engagement, Project Management and Remote Office leadership and guidance.

Preferred Work Location: Ohio

Knowledge/Skills/Abilities Duties and Responsibilities (List all essential duties and responsibilities in order of importance):

• Serve as Health Plan point of contact
• Ensure all Shared Service areas and Functions understanding priorities and issues for the Health Plan.
• Collaborate with Shared Services to ensure they understand and are fulfilling Health Plan requests and commitments
• 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.
• 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 & outcome measurement.
• 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.
• Identify and drive new initiatives to optimize systems' performance and leverage functionality to:
• Increase claims payment accuracy and auto-adjudication
• Increase members and provider satisfaction
• Identify and implement cost savings initiatives in contracting, operations and employee productivity
• Avoid work-arounds and unplanned re-work.
• Ensure the overall level of quality for operational and contractual obligations meet or exceed appropriate standards.
• Provide personal leadership that encourages employee productivity and responsiveness to the needs of the current and prospective members, providers and regulatory agencies/staff.
• Ensure programs are established to comply with all relevant federal, state and local regulations.
• State Plan / Department Specific Duties and Responsibilities (List all essential duties other than those listed above in order of importance):
• Overall management of various departments/functions in multiple office locations which could include:
• Network Management and Operations
• Health Plan Operations
• Other Functional Areas as Needed
• Other duties:
• Project Management
• Represent the Health Plan on various committees and work groups within the Shared Services Team
• Other duties as requested

Job Qualifications

Required Education: Bachelors' degree in Business, Health Services Master's Degree in Business, Policy, Public Administration or Health Services Administration or related field.

Required Experience: 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.

Preferred Education: Master's or PhD Degree in public health, social or behavioral services or similar discipline

Preferred Experience: 10+ years in public health, social or behavioral services, or similar field; 3+ years in a direct or matrix leadership position

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.