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Job Description

Job Summary

Leads clinical systems, automation, integration, implementation and process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in development of MHI's business process improvement methodology and in the implementation of a business process improvement capability. Responsible for evaluating existing processes and configuring clinical systems to reduce cost and develop best practices within clinical programs.

Knowledge/Skills/Abilities

• Optimizes and improves clinical systems, business processes and productivity using understanding of key revenue levers, cost drivers and customer satisfaction impacts of business processes

• Leads process improvement initiatives and implementation with defined objectives and measurable results

• Works with business sponsors to develop clear definitions of business process improvement opportunities and establish measurable goals/objectives

• Engages cross-functional areas & health plans (e.g. product, configuration, UM, Care Management, provider network, claims) for requirements planning

• Makes recommendations on scope and priorities for improvement initiatives, assesses for opportunities for vendor solutions.

• Develops and optimizes processes to achieve the output, quality, and cost goals of the organization.

• Plans and executes process improvement initiatives, leading work streams of significant scope, typically requiring cross-functional integration

• Focuses on improving operational fundamentals and effectiveness; uses expertise to make operating processes more nimble and sustainable

• Ensures that on-going work following a system implementation or improvement initiative is identified, planned, assigned and successfully deployed

• Researches and engages industry, evaluates, and provides industry insights, competitor best practices as applicable for adoption or use by Molina

• Conducts or coordinates post-implementation initiative review to measure results and report to health plan partners, senior management & stakeholders

• Provides summary analysis of clinical systems automation, implementation, integration and compliance based issues, to influence product revisions

• Coaches and mentors other Molina leaders and staff in the system application of business process improvement, implementation and intergration

• Manages a team of product owners, Program Managers and Subject Matter Experts responsible for implementation of approved initiatives

• Responsible for coaching the team on Agile, Scrum, Quality Improvement methodologies for application on enterprise initiatives

• Builds company specific systems and technology expertise across multiple infrastructure and development disciplines.

• Responsible for areas of strategic planning for architecture standards, roadmaps, budgets, programs and projects.

• Responsible for providing expertise of major industry trends such as cloud technologies, automation, agile methodologies, etc.

• Ownership to provide cross-organization teamwork, collaboration, communication and leadership.

• Provides constructive feedback on people, process and technology for continuous improvement.

• Relationship building with IT leadership, technical engineers, program managers, support leads, and external vendors to understand and solve problems. Accountable for insuring compliance with contractual, accreditation and regulatory requirements

• Partners with Compliance to ensure system features impacting regulatory requirements are addressed via a Corrective Action Plan in collaboration with IT..

Job Qualifications

Required Education

Bachelor's degree required in a related field (Business Administration, etc.)

Required Experience

• 10 years minimum experience in Healthcare.

• Extensive management level experience or understanding of all areas of health plan operations: claims processing, customer service/call center, provider contracting, benefit design and configuration, product development, membership accounting and enrollment, operational systems, provider contracting, authorizations/referrals, utilization management.

• Understands key revenue levers and cost drivers of business processes.

• Understands critical success factors for the industry.

• Experience designing and delivering solutions related to operational improvement functions.

• Experience implementing new systems and systems processes

• Strong leadership qualities and ability to get results.

Required License, Certification, Association

LEAN six sigma black belt

Preferred Education

Masters degree in Business Administration or a related field

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: $186,201.39 - $363,093 / ANNUAL

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