AVP, Core Operations

JOB DESCRIPTION

Job Summary

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 issues.

KNOWLEDGE/SKILLS/ABILITIES

• Implements company-wide initiatives relevant to Claims Production, including Claims Production, Audit, and Production Vendor Oversight.
• Leads activities supporting claims production, such as the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, and Corporate Encounter Team. Provides organizational leadership of claims editing and recovery vendors to manage healthcare costs.
• Engages with IT and other departments to implement changes to business processes and systems for Corporate Operations PMO.
• Implements Corporate Configuration of the QNXT system and the Care Management application for UM functions within QNXT, enabling the system to produce expected costs.
• Ensures compliance with state regulatory requirements, maximizes MASS Adjudication within QNXT, improves process quality, reduces G&A costs, and drives positive operational and financial outcomes across initiatives.

JOB QUALIFICATIONS

Required Education

Graduate Degree or equivalent combination of education and experience.

Required Experience

7-9 years.

Preferred Education

Graduate Degree or equivalent combination of education and experience.

Preferred Experience

10+ years.

To all current Molina employees: If interested in applying, please do so through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $140,795 - $274,550 / ANNUAL

*Actual compensation may vary based on location, experience, education, and skills.