VP, Marketplace Clinical Operations (REMOTE)

$161,914 - $315,733/Yr

Molina Healthcare - Richmond, KY

Full-time - Executive

Remote - Richmond, KY

Insurance Carriers and Related Activities

About the position

The VP, Marketplace Clinical Operations at Molina Healthcare is responsible for leading a team that coordinates integrated care delivery for members with high needs, encompassing both physical and behavioral health. This role involves ensuring quality, cost-effective healthcare services, compliance with regulations, and fostering team engagement to achieve optimal member outcomes.

Responsibilities

• Provides leadership, direction and oversight to the segment clinical teams, specifically care management and utilization management.
• Leads, manages, and implements effective standards, protocols, processes, decision support systems, reporting and benchmarks for clinical operations.
• Ensures clinical models for care and utilization management meet federal and state requirements while addressing the needs of the Marketplace population.
• Partners with enterprise teams to ensure appropriate technical systems support team success.
• Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores.
• Offers leadership in medical management initiatives and analytical studies to optimize resource utilization and operational efficiencies.
• Engages with the provider community to identify opportunities for improving member outcomes.
• Oversees compliance with contractual, accreditation, and regulatory requirements in clinical operations.
• Creates a culture that fosters team engagement and retention.
• Responsible for oversight of healthcare services related to delegation oversight monitoring.
• Oversees medical management decisions to maximize member benefits and support corporate objectives.
• Coordinates clinical activities with Molina corporate vendors and state plans.
• Coordinates audits to improve team performance.

Requirements

• Bachelor's Degree in Healthcare, Business, or a related field.
• 10 years managed care experience with management responsibility including clinical operations.
• Experience working within applicable state, federal, and third-party regulations.
• Operational and process improvement experience.
• Strong communication and interpersonal skills.
• Strong leadership capabilities and ability to maintain cross-team relationships.

Nice-to-haves

• Masters Degree in Business or Healthcare management (i.e. MBA, MHA, MPH).
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• Utilization Management Certification (CPHM) or Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.

Benefits

• Competitive benefits and compensation package.