JOB DESCRIPTION

Job Summary

Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services.

KNOWLEDGE/SKILLS/ABILITIES

Establishes audit controls and measurements to ensure correct processes are established. Develops and performs internal audits/risk assessments, monitoring program for Molina Healthcare departments. Provides post audit findings and recommendations to ensure contractual State and Federal Compliance. Coordinates development of written policies and procedures regarding compliance with local, state and federal guidelines. Establishes member grievance appeals and policies and updates annually or as directed by the Centers for Medicare and Medicaid Services. Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the Center for Medicare and Medicaid. Responsible for development, implementation, and maintenance of department strategic initiatives.

JOB QUALIFICATIONS

Required Education

Graduate Degree or equivalent combination of education and experience

Required Experience

7-9 years

Preferred Experience

10+ years

 

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.