Job Details

Overview

Job Description: Director, Operational Oversight (Medicare)

Responsible for planning, developing and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve.

Responsibilities

• Oversee regulatory compliance of Corporate Operations functions, including internal compliance audits and representation on external regulatory audits.
• Provide oversight for function support areas requiring consistent oversight; travel up to 25% may be required.
• Define program scope, establish implementation approaches, and maintain program infrastructure.
• Develop methods to assess program effectiveness and cadence for assessment and adjustment.
• Monitor internal compliance of Corporate Operations units via an internal compliance program, including annual and periodic audits.
• Lead Performance Management & KPI efforts: develop, implement, and monitor KPIs (leading and lagging indicators); set and align team goals; diagnose root causes of misses; drive accountability across functions.
• Data Insight & Decision Support: ingest and interpret complex data from multiple sources, perform root cause analysis, generate actionable insights, evolve KPI/leading indicator frameworks, and build Power BI dashboards for data visualization and performance tracking.
• Review and oversee internal corrective action plans (CAPs) for internal and external audit findings; coordinate responses to ensure appropriateness related to findings.
• Develop and maintain education and coaching for all staff levels; evaluate training needs and maintain curriculum and supporting materials for process improvement.
• Facilitate Lean improvement workshops in partnership with managers; mentor/coach leadership to promote Lean concepts and tools.
• Identify and prioritize process improvement opportunities; assist in prioritization of approved initiatives/projects.
• Serve as primary liaison between regulatory auditors and corporate operations units; coordinate from notification through analysis and response to findings.
• Organize audit submissions and interact with auditors for all lines of business.
• Provide Delegation Oversight as a voting representative for delegation oversight committees.
• Review and approve Corporate Operations policies, procedures, guidelines and job aids to ensure compliance with corporate or state regulations.
• Develop and maintain Corporate Operations Compliance program, including policies, procedures, audits and monitoring.
• Coordinate with Corporate Legal on legal actions (e.g., third-party liability suits, provider and member suits) and maintain awareness of applicable laws, regulations, and statutes in states where Molina operates.
• Explain and apply accepted methodologies for process improvement and performance analysis; coordinate with enterprise Operational Excellence teams to ensure alignment.
• Collaborate with Molina enterprise Operational Excellence and health plan Operational Excellence teams; ensure alignment with organizational programs.
• Develop an organizational communication approach for the program; interpret regulations affecting Corporate Operations policies and ensure inclusion in documents.
• Act as liaison for health plans on OIG, OAG and other state requests for data; coordinate with the corporation's special investigative unit as needed.
• Assist with Request for Proposal responses; work with Corporate Operations leadership to maintain operational effectiveness and compliance.
• Foster cooperation through effective relationship-building with health plan compliance and government contract personnel.

Job Qualifications

Required Education

• Bachelor's degree or equivalent years of experience in Healthcare Administration

Required Experience

• 7 years of managed care experience
• Previous management experience of 5 years or more

Preferred Education

• Master's degree - Healthcare Administration

Preferred Experience

• 6 years of healthcare related process improvement experience with demonstrable successes in application of Lean/Six-Sigma
• 10 years of process improvement experience

Preferred License, Certification, Association

• LEAN certification and/or Lean Six Sigma Black Belt

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.