Molina Healthcare

AVP, Core Operations

Molina Healthcare$100K — $130K *
Finance & Insurance
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Graduate degree or equivalent combination of education and experience
  • 7-9 years relevant experience, with 10+ preferred
  • Strong experience with Claims Production and Vendor Oversight
  • Proficient in healthcare operations and regulations
  • Expertise in QNXT system and Care Management applications

Responsibilities

  • Plan and implement performance maintenance techniques for products and processes
  • Review and establish operational standards for process designs
  • Lead the production and compliance activities of claims management teams
  • Engage with cross-functional teams to enhance business processes
  • Ensure compliance with state regulations and maximize system capabilities

Benefits

  • Comprehensive health benefits package
  • Opportunities for professional development
  • Supportive work culture that values diversity
  • Flexible scheduling options to promote work-life balance
  • Access to resources for career growth
Full Job Description
Job Description

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

KNOWLEDGE/SKILLS/ABILITIES
  • Implements companywide initiatives relevant to Claims Production, i.e., Claims Production, Audit, Production Vendor Oversight.
  • Leads activities supporting the production of claims including but not limited to the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, Corporate Encounter Team as well as providing overall organizational leadership of claims editing and recovery vendors aimed at managing overall 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 as well as the Care Management application for UM functions within QNXT and enables system to produce expected costs.
  • Ensures state regulatory requirements are met, maximizes MASS Adjudication within QNXT, improves process quality, reduces G&A costs, and continues to drive positive operational and financial outcomes within all 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 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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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