Director, Operational Oversight (Medicare) – REMOTE

Molina Healthcare; Albuquerque (NM); Remote; USD 79,000 - 173,000; Full time

Job summary

A leading healthcare organization in Albuquerque seeks a Director for Operational Oversight to ensure performance and quality within the business. The ideal candidate will have significant experience in managed care, a strong background in process improvement, and a proven ability to guide teams toward efficient operations. This full-time role offers a competitive salary and benefits package.

Benefits

Competitive benefits package

Qualifications

• 7+ years of managed care experience required.
• 5+ years of management experience required.
• LEAN certification or Lean Six Sigma Black Belt is preferred.

Responsibilities

• Define program scope and maintain program infrastructure.
• Develop methods for assessing program effectiveness.
• Monitor internal compliance via an established program.

Skills

Program management

KPI development

Data analysis

Lean methodologies

Communication

Education

Bachelor's degree in Healthcare Administration

Master's degree in Healthcare Administration

Tools

Power BI

Job description

Overview

Job Description: Director, Operational Oversight (Medicare)

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.

Responsibilities

• Defines program scope, establish approach for implementation and maintain program infrastructure
• Develop a method for assessing program effectiveness and a cadence for assessing and adjusting
• Monitor internal compliance of Corporate Operations units via establishment of an internal compliance program, including annual, periodic, focal, etc. audits.
• Performance Management & KPI Expertise: Develop, implement, and monitor KPIs, including leading and lagging indicators. Set and align team goals, ensure adherence, diagnose root causes of misses, and drive accountability across functions.
• Data Insight & Decision Support: Ingest and interpret complex data from multiple sources, conduct root cause analysis, and generate actionable insights. Guide business decisions, evolve KPI/leading indicator frameworks, and build new Power BI dashboards for data visualization and performance tracking.
• Request, review and perform oversight of internal corrective action plans (CAPs) for both internal and external audit findings via coordination of responses to assure appropriateness as it relates to the finding.
• Establish and maintain an education and coaching approach for all levels of staff. Continuously evaluates training and coaching needs of the organization as it relates to process improvement. Develops and maintains the necessary curriculum and supporting materials to education staff and leaders.
• Facilitates Lean improvement workshops in partnership with managers; develops and delivers presentations/education to mentor/coach various key leadership and management staff to promote awareness, understanding, acceptance and engagement of Lean concepts, methodologies and tools.
• Gains agreement on process improvement opportunities to be undertaken and assists in the prioritization of approved initiatives/projects.
• Primary liaison between regulatory auditors and corporate operations business units, leadership and line personnel from receipt of notification from regulatory agency through analysis and response to findings.
• Organize audit submissions, interact directly with auditors for all lines of business as it relates to audits.
• Delegation Oversight; voting representative for delegation oversight committees.
• Performs support via review and approval for Corporate Operations policies, procedures, guidelines and job aids to assure compliance with corporate or state regulations.
• Develop and maintain Corporate Operations Compliance program, including compliance policies, procedures and implementation of audits and monitoring.
• Corporate Operations liaison to Corporate Legal to address legal actions, e.g. third-party liability suits, provider and other such member suits.
• Maintain an awareness of current laws, regulations, statutes, etc. for each state that Molina operates in that impacts Corporate Operations compliance.
• Explains and applies accepted methodologies (i.e. identify desired outcomes, analyze current processes/problems, collect/analyze relevant data, uncover root causes, develop performance/process improvement plan and implementation tactics, test recommendation and assess results.)
• Coordinates and collaborates with Molina enterprise Operational Excellence team and health plan Operational Excellence teams
• Ensures appropriate alignment within the program with organizational Operational Excellence programs.
• Develop approach for communication organizationally about the program
• Analyze and interpret with possible assistance from Molina Health Plans regulations that affect Corporate Operations policies, procedures and guidelines and work with internal leadership to assure inclusion in such documents.
• Liaison for health plans for all OIG, OAG and other state office of internal/attorney general requests for data.
• Liaison with the corporation’s special investigative unit.
• Assists with Request for Proposal responses.
• Proactively work with Corporate Operations leadership on operational effective to assure compliance.
• Persuade and instill effective cooperation to assure compliance via developing rapport with health plan compliance and government contract personnel.

Qualifications

Required Education

Bachelor’s degree or equivalent years of experience in Healthcare Administration

Required Experience

• 7 years of managed care experience
• Previous management experience of 5 years or more

Preferred Education

Master’s degree – Healthcare Administration

Preferred Experience

• 6 years of healthcare related process improvement experience with demonstrable successes in application of Lean/Six-Sigma
• 10 years of process improvement experience.

Preferred License, Certification, Association

• LEAN certification and/or Lean Six Sigma Black Belt

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.

Pay Range: $79,607.91 – $172,483.8 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.