AVP, Arizona Health Plan Operations (Must reside in AZ)

$122,430 - $238,739/Yr

Molina Healthcare - Phoenix, AZ

Full-time - Mid Level

Phoenix, AZ

1,001-5,000 employees

Insurance Carriers and Related Activities

About the position

The AVP of Arizona Health Plan Operations is responsible for overseeing the development and administration of the State Health Plan's operational departments, programs, and services. This role ensures compliance with federal, state, and local regulations while aligning with Molina Healthcare's mission and strategic plan. The position involves directing Health Plan Operations, managing performance metrics, and serving as a liaison for various operational departments.

Responsibilities

• Direct and coordinate Health Plan Operations under the leadership of the Plan President.
• Ensure Health Plan Operating metrics meet compliance requirements and performance targets.
• Plan, organize, staff, and coordinate operations for Medicaid/CHIP, Medicare, and Marketplace Health Plans.
• Develop and implement improvements for non-clinical Health Plan operations.
• Serve as the Senior Plan leader and liaison for MHI Service Operations, including Claims, Enrollment, and IT.
• Track and report MHI Service Operations performance to Plan leadership.
• Escalate performance issues to the Plan President with action plans for mitigation.
• Identify and adopt best practices for Health Plan and MHI Service Operations.
• Manage the Plan's benefit configuration and claims payment policies.
• Lead efforts to audit provider contract loads and claims payments.

Requirements

• Bachelor's Degree in Business, Health Services Administration, or related field.
• 7-10 years of experience in Healthcare Administration, Health Plan Operations, Managed Care, or Provider Services.
• Experience managing and supervising employees.
• Demonstrated adaptability to a rapidly moving business environment.

Nice-to-haves

• Master's Degree in Business, Health Administration, or related field.
• Experience with Medicaid and Medicare managed care plans.

Benefits

• Health insurance