JOB DESCRIPTION
Job Summary
Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials.
KNOWLEDGE/SKILLS/ABILITIES
Under the direction of the VP Health Plan Operations, identifies and initiates continuous quality improvements regarding member engagement and member retention.
Oversees operational areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials.
Ensures access and availability for all Molina members to voice concerns, request for member information and benefit interpretation. Represents Member issues on the Plan's Senior Leadership Team.
Liaisons with Contact Center- reviews call metrics and root cause analyses of common member complaints; ensures communication and collaboration to address process and training opportunities.
Liaisons with Enrollment/Membership Accounting - monitors open projects and provides support to escalate as needed; addresses process and training opportunities to ensure compliance with plan requirements for all lines of business.
Responsible for member retention targets for all lines of business. Develops, coordinates, and leads a Continuous Quality Improvement program for member-related activities. Ensures that employees and management are knowledgeable of, and participate in identifying and implementing, opportunities for improvement to support member retention.
Develops and maintains all member materials; coordinates communications with members; and ensures that member materials meet contract and regulatory requirements.
Maintains knowledge of Molina contractual obligations with the State, its members, and other parties; works with other departments to ensure compliance with contractual obligations.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree in Business or Health Care Administration or equivalent experience.
Required Experience
Min. 7 years relevant/related experience, including at least 5 in the health plan/insurance industry.
3+ years' experience in a managed care environment; preferably in Medicaid.
More than 1 year of experience in a management role.
Preferred Education
Bachelor's or master's degree in Business or Health Care Administration.
Preferred Experience
10+ yearsTo 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.
Pay Range: $92,474 - $188,164 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.