Description
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
Bachelors 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 masters degree in Business or Health Care Administration.
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.
Pay Range: $92,474 – $188,164 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.