5 Healthcare jobs in Morgantown
Regional Vice President, Support Services Operations (Healthcare)
42102 Bowling Green, Kentucky
Sodexo
Posted 1 day ago
Job Viewed
Job Description
**Role Overview**
Sodexo's Healthcare segment is seeking a **Regional Vice President, Support Services Operations** for SSM Health in **St. Louis, MO.** This role has full accountability for our client organization relationships which includes multiple contracts, services (Food, EVS, etc), and locations.
Sodexo is the premier client partner in delivering high-quality and intuitive solutions to healthcare organizations through operational excellence and innovative solutions. As we continue to grow and evolve, we are seeking a forward-thinking _Regional_ _Vice President_ to lead the development and execution of our operational strategies. This key leadership position requires a strategic visionary with experience navigating client solutions, building C-suite relationships, and leveraging data to drive decision-making.
**Incentives**
This is a remote position, requiring ~50% travel. Candidates must live in the Midwest region. Relocation assistance available.
**What You'll Do**
**Position Summary:**
As the Regional Vice President, Support Services Operations you will be responsible for leading the organization's operational strategy, enhancing client relationships, and ensuring operational excellence across our support services. You will leverage your financial acumen and data-driven decision-making skills to navigate complex client solutions, drive organizational change, and implement strategies that enhance performance and accountability. Your leadership will help ensure we deliver best-in-class services, driving both client satisfaction and financial success.
**Key Responsibilities:**
+ **Strategic Leadership:** Develop and execute strategic initiatives that drive operational performance and align with organizational goals, with a particular focus on support services such as Foodservice and Environmental Services (EVS), as well as others.
+ **Client Solutions & Relationship Management:** Build and sustain strong relationships with C-suite clients and key stakeholders, providing tailored solutions to meet their needs and ensuring ongoing satisfaction and retention.
+ **Change Management:** Foster a culture of change, guiding the organization through transformative initiatives that improve operations, drive efficiency, and enhance service delivery.
+ **Financial Stewardship:** Lead financially driven decision-making to ensure that strategic initiatives are not only operationally sound but also financially sustainable. Ensure profitability and cost-effectiveness in all support service operations.
+ **Operational Excellence:** Oversee the implementation of best practices, processes, and performance standards to achieve operational excellence in support services, ensuring high-quality and efficient delivery of services.
+ **Data-Driven Decision Making:** Utilize detailed data analysis and operational metrics to drive decisions, enhance performance, and optimize operational processes. Provide actionable insights to stakeholders across the organization.
+ **Accountability & Results:** Set clear expectations, establish key performance indicators (KPIs), and hold teams accountable for delivering results. Maintain high standards of accountability, ensuring all operational goals are met.
+ **Leadership Development:** Foster a culture of leadership development by identifying, mentoring, and cultivating the next generation of leaders within the organization, ensuring a sustainable leadership pipeline.
+ **Collaboration:** Work closely with other senior leaders to ensure seamless integration of client solutions and operational strategies across departments, driving cross-functional alignment and effectiveness.
**What We Offer**
Compensation is fair and equitable, partially determined by a candidate's education level or years of relevant experience. Salary offers are based on a candidate's specific criteria, like experience, skills, education, and training. Sodexo offers a comprehensive benefits package that may include:
+ Medical, Dental, Vision Care and Wellness Programs
+ 401(k) Plan with Matching Contributions
+ Paid Time Off and Company Holidays
+ Career Growth Opportunities and Tuition Reimbursement
More extensive information is provided to new employees upon hire.
**What You Bring**
**Qualifications:**
+ Bachelor's degree in Business Administration, Healthcare Management, or a related field.
+ 10+ years of progressive leadership experience in strategic operations, client solutions, and support services management, preferably in healthcare settings.
+ Strong experience in building and maintaining C-suite client relationships, with a focus on solution-driven outcomes and business growth.
+ Demonstrated success in driving change management initiatives and cultivating a culture of operational excellence, accountability, and continuous improvement.
+ Strong financial acumen with experience managing budgets, optimizing resources, and ensuring financial sustainability in support service operations.
+ Expertise in data analysis, leveraging detailed data to inform decision-making and operational improvements.
+ Excellent communication, leadership, and interpersonal skills, with the ability to collaborate and influence at all levels of the organization.
If you are a results-driven, financially savvy leader with a proven track record of building relationships, managing complex operations, and driving excellence, we invite you to apply for the Regional Vice President position. Join us in shaping the future of healthcare support services.
**Who We Are**
At Sodexo, our purpose is to create a better everyday for everyone and build a better life for all. We believe in improving the quality of life for those we serve and contributing to the economic, social, and environmental progress in the communities where we operate. Sodexo partners with clients to provide a truly memorable experience for both customers and employees alike. We do this by providing food service, catering, facilities management, and other integrated solutions worldwide.
Our company values you for you; you will be treated fairly and with respect, and you can be yourself. You will have your ideas count and your opinions heard because we can be a stronger team when you're happy at work. This is why we embrace diversity and inclusion as core values, fostering an environment where all employees are valued and respected. We are committed to providing equal employment opportunities to individuals regardless of race, color, religion, national origin, age, sex, gender identity, pregnancy, disability, sexual orientation, military status, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. If you need assistance with the application process, please completethis form ( .
**Qualifications & Requirements**
Minimum Education Requirement - Bachelor's Degree or equivalent experience
Minimum Management Experience - 10 years
Minimum Functional Experience - 10 years related functional experience
**Location** _US-MO-St. Louis | US-KY-Bowling Green | US-IL-Chicago | US-MI-Grand Rapids | US-WI-Milwaukee | US-OK-Tulsa | US-KS-Wichita_
**System ID** _980487_
**Category** _General Management_
**Employment Status** _Full-Time_
_Exempt_
**Posted Range** _$157300 to $237820_
**Company : Segment Desc** _HOSPITALS_
_Remote_
Sodexo's Healthcare segment is seeking a **Regional Vice President, Support Services Operations** for SSM Health in **St. Louis, MO.** This role has full accountability for our client organization relationships which includes multiple contracts, services (Food, EVS, etc), and locations.
Sodexo is the premier client partner in delivering high-quality and intuitive solutions to healthcare organizations through operational excellence and innovative solutions. As we continue to grow and evolve, we are seeking a forward-thinking _Regional_ _Vice President_ to lead the development and execution of our operational strategies. This key leadership position requires a strategic visionary with experience navigating client solutions, building C-suite relationships, and leveraging data to drive decision-making.
**Incentives**
This is a remote position, requiring ~50% travel. Candidates must live in the Midwest region. Relocation assistance available.
**What You'll Do**
**Position Summary:**
As the Regional Vice President, Support Services Operations you will be responsible for leading the organization's operational strategy, enhancing client relationships, and ensuring operational excellence across our support services. You will leverage your financial acumen and data-driven decision-making skills to navigate complex client solutions, drive organizational change, and implement strategies that enhance performance and accountability. Your leadership will help ensure we deliver best-in-class services, driving both client satisfaction and financial success.
**Key Responsibilities:**
+ **Strategic Leadership:** Develop and execute strategic initiatives that drive operational performance and align with organizational goals, with a particular focus on support services such as Foodservice and Environmental Services (EVS), as well as others.
+ **Client Solutions & Relationship Management:** Build and sustain strong relationships with C-suite clients and key stakeholders, providing tailored solutions to meet their needs and ensuring ongoing satisfaction and retention.
+ **Change Management:** Foster a culture of change, guiding the organization through transformative initiatives that improve operations, drive efficiency, and enhance service delivery.
+ **Financial Stewardship:** Lead financially driven decision-making to ensure that strategic initiatives are not only operationally sound but also financially sustainable. Ensure profitability and cost-effectiveness in all support service operations.
+ **Operational Excellence:** Oversee the implementation of best practices, processes, and performance standards to achieve operational excellence in support services, ensuring high-quality and efficient delivery of services.
+ **Data-Driven Decision Making:** Utilize detailed data analysis and operational metrics to drive decisions, enhance performance, and optimize operational processes. Provide actionable insights to stakeholders across the organization.
+ **Accountability & Results:** Set clear expectations, establish key performance indicators (KPIs), and hold teams accountable for delivering results. Maintain high standards of accountability, ensuring all operational goals are met.
+ **Leadership Development:** Foster a culture of leadership development by identifying, mentoring, and cultivating the next generation of leaders within the organization, ensuring a sustainable leadership pipeline.
+ **Collaboration:** Work closely with other senior leaders to ensure seamless integration of client solutions and operational strategies across departments, driving cross-functional alignment and effectiveness.
**What We Offer**
Compensation is fair and equitable, partially determined by a candidate's education level or years of relevant experience. Salary offers are based on a candidate's specific criteria, like experience, skills, education, and training. Sodexo offers a comprehensive benefits package that may include:
+ Medical, Dental, Vision Care and Wellness Programs
+ 401(k) Plan with Matching Contributions
+ Paid Time Off and Company Holidays
+ Career Growth Opportunities and Tuition Reimbursement
More extensive information is provided to new employees upon hire.
**What You Bring**
**Qualifications:**
+ Bachelor's degree in Business Administration, Healthcare Management, or a related field.
+ 10+ years of progressive leadership experience in strategic operations, client solutions, and support services management, preferably in healthcare settings.
+ Strong experience in building and maintaining C-suite client relationships, with a focus on solution-driven outcomes and business growth.
+ Demonstrated success in driving change management initiatives and cultivating a culture of operational excellence, accountability, and continuous improvement.
+ Strong financial acumen with experience managing budgets, optimizing resources, and ensuring financial sustainability in support service operations.
+ Expertise in data analysis, leveraging detailed data to inform decision-making and operational improvements.
+ Excellent communication, leadership, and interpersonal skills, with the ability to collaborate and influence at all levels of the organization.
If you are a results-driven, financially savvy leader with a proven track record of building relationships, managing complex operations, and driving excellence, we invite you to apply for the Regional Vice President position. Join us in shaping the future of healthcare support services.
**Who We Are**
At Sodexo, our purpose is to create a better everyday for everyone and build a better life for all. We believe in improving the quality of life for those we serve and contributing to the economic, social, and environmental progress in the communities where we operate. Sodexo partners with clients to provide a truly memorable experience for both customers and employees alike. We do this by providing food service, catering, facilities management, and other integrated solutions worldwide.
Our company values you for you; you will be treated fairly and with respect, and you can be yourself. You will have your ideas count and your opinions heard because we can be a stronger team when you're happy at work. This is why we embrace diversity and inclusion as core values, fostering an environment where all employees are valued and respected. We are committed to providing equal employment opportunities to individuals regardless of race, color, religion, national origin, age, sex, gender identity, pregnancy, disability, sexual orientation, military status, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. If you need assistance with the application process, please completethis form ( .
**Qualifications & Requirements**
Minimum Education Requirement - Bachelor's Degree or equivalent experience
Minimum Management Experience - 10 years
Minimum Functional Experience - 10 years related functional experience
**Location** _US-MO-St. Louis | US-KY-Bowling Green | US-IL-Chicago | US-MI-Grand Rapids | US-WI-Milwaukee | US-OK-Tulsa | US-KS-Wichita_
**System ID** _980487_
**Category** _General Management_
**Employment Status** _Full-Time_
_Exempt_
**Posted Range** _$157300 to $237820_
**Company : Segment Desc** _HOSPITALS_
_Remote_
View Now
0
Senior Analyst, Healthcare Analytics (Risk Adjustment) - REMOTE
42102 Bowling Green, Kentucky
Molina Healthcare
Posted 1 day ago
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compiling and organizing health care data using Databricks and Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic / programming tools as needed
+ Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, annual and quarterly forecasts, and regular deep dives to drive improvement in financial results
+ Take ownership with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
+ Create databases and reporting dashboards for monitoring, tracking and trending based on project specifications and applies automation as appropriate
+ Complete analysis and forecasting of risk adjustment intervention program values
+ Develop and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model for Medicaid members, and others as needed
+ Must have a strong attention to detail and knowledge of data structure and programming
+ Performing financial analysis to assist in delivering optimal health care management and decision making
+ Understanding and applying data storage and data sharing best practices
+ Converting data into usable information that is easy to understand and provides insights needed to support strategic investment decisions
+ Research and develop reports and analyses for senior management and effectively and concisely communicate results and key takeaways
+ Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework
+ Practice strong judgement in carrying out work independently, consult with experts as needed and use available resources and reports to critique results
+ Manage multiple projects and consistently deliver results on time in a fast-paced environment with changing priorities
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, analyzing, and reporting financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of SQL
+ Proficient in Excel and visualization tools such as Power BI, Tableau, or similar
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
+ Analysis and forecasting of program value and underlying population trends in risk adjustment to provide analytic support for finance, pricing and actuarial functions
+ Healthcare Analyst I or Financial/Accounting Analyst I experience desired
+ Multiple data systems and models
+ Data modelling and BI tools
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: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compiling and organizing health care data using Databricks and Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic / programming tools as needed
+ Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, annual and quarterly forecasts, and regular deep dives to drive improvement in financial results
+ Take ownership with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
+ Create databases and reporting dashboards for monitoring, tracking and trending based on project specifications and applies automation as appropriate
+ Complete analysis and forecasting of risk adjustment intervention program values
+ Develop and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model for Medicaid members, and others as needed
+ Must have a strong attention to detail and knowledge of data structure and programming
+ Performing financial analysis to assist in delivering optimal health care management and decision making
+ Understanding and applying data storage and data sharing best practices
+ Converting data into usable information that is easy to understand and provides insights needed to support strategic investment decisions
+ Research and develop reports and analyses for senior management and effectively and concisely communicate results and key takeaways
+ Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework
+ Practice strong judgement in carrying out work independently, consult with experts as needed and use available resources and reports to critique results
+ Manage multiple projects and consistently deliver results on time in a fast-paced environment with changing priorities
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, analyzing, and reporting financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of SQL
+ Proficient in Excel and visualization tools such as Power BI, Tableau, or similar
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
+ Analysis and forecasting of program value and underlying population trends in risk adjustment to provide analytic support for finance, pricing and actuarial functions
+ Healthcare Analyst I or Financial/Accounting Analyst I experience desired
+ Multiple data systems and models
+ Data modelling and BI tools
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: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
1
Senior Analyst, Healthcare - Claims Resolution - Remote
42102 Bowling Green, Kentucky
Molina Healthcare
Posted 1 day ago
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.
This position is responsible for proactively identifying claim issues, resolving disputes, and coordinating solutions while overseeing and managing the activities of assigned providers from initiation to completion of the program. This role contributes to the strategic direction and organization of health plan initiatives, facilitating the successful implementation of provider engagement programs.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Analyze claims from compliance against contracts, billing, and processing guidelines
+ Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
+ Responsible for timely completion of projects, including timeline development and maintenance, and coordination of activities and data collection with requesting internal departments or external requestors.
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ Collaborates with internal departments to determine root cause and analytical approach to payment discrepancies.
+ Apply investigative skills and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modleing, etc.
+ Interact with various departments including; IT, Contracting, Corporate Services, Claims, Utilization Management. Configuration and Payment Integrity to understand claim related policies and payment processes, member benefits, contracts and State requirements
+ Responsible for documenting job aids, billing guidelines, policies and procedures related to operations
+ Responsible for the submission, research, and resolution of provider inquiries and/or esclations
+ Participate in and support the development of strategies to meet the business needs
+ Clarifies and supports organization policies and procedures
+ Communicate contract terms, payment structures, and reimbursement rates to physician,hospitals and ancillary providers.
+ Implement and use software and systems to support the department's goals.
+ Strong knowledge of provider data/processes/requirements related to provider contracting, credentialing, claims processing and state/federal regulations
+ Ability to interpret,communicate, and suggest revisions to core claims operation and data configuration SOP's, BRDs, and/or guidelines as needed
+ Identify and implement continuous improvement opportunities as needed
+ Ability to manage various sources of information and large data sets including pharmacy, claims and encounter data
+ Proficiency in compiling data, creating reports and presenting information, including knowledge of Power BI Reports (or similar reporting tool), SQL query, MS Access and MS Excel
+ Ability to combine clinical and financial data
+ Demonstrated ability to meet established deadlines
+ Ability to function independently and manage multiple projects
+ Ability to develop scenario analysis using different approaches
+ Ability to present ideas and information concisely to varied audiences
+ Proficiency with PC-based systems, and the ability to learn other systems through knowledge of MS Excel and AccessExcellent verbal and written communication skills
+ Ability to quickly assimilate knowledge of processes and systems to develop and deliver necessary training to departmental staff and internal customers
+ Ability to work in a deadline driven department
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Basic knowledge of SQL
+ Preferred Education
+ Bachelor's Degree in Finance, Economics, Math, or Computer Science
**Preferred Experience**
+ Multiple data systems and models
+ Complex database and data management responsibilities
+ Claims processing background
+ Configuration background
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: $63,133 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.
This position is responsible for proactively identifying claim issues, resolving disputes, and coordinating solutions while overseeing and managing the activities of assigned providers from initiation to completion of the program. This role contributes to the strategic direction and organization of health plan initiatives, facilitating the successful implementation of provider engagement programs.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Analyze claims from compliance against contracts, billing, and processing guidelines
+ Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
+ Responsible for timely completion of projects, including timeline development and maintenance, and coordination of activities and data collection with requesting internal departments or external requestors.
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ Collaborates with internal departments to determine root cause and analytical approach to payment discrepancies.
+ Apply investigative skills and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modleing, etc.
+ Interact with various departments including; IT, Contracting, Corporate Services, Claims, Utilization Management. Configuration and Payment Integrity to understand claim related policies and payment processes, member benefits, contracts and State requirements
+ Responsible for documenting job aids, billing guidelines, policies and procedures related to operations
+ Responsible for the submission, research, and resolution of provider inquiries and/or esclations
+ Participate in and support the development of strategies to meet the business needs
+ Clarifies and supports organization policies and procedures
+ Communicate contract terms, payment structures, and reimbursement rates to physician,hospitals and ancillary providers.
+ Implement and use software and systems to support the department's goals.
+ Strong knowledge of provider data/processes/requirements related to provider contracting, credentialing, claims processing and state/federal regulations
+ Ability to interpret,communicate, and suggest revisions to core claims operation and data configuration SOP's, BRDs, and/or guidelines as needed
+ Identify and implement continuous improvement opportunities as needed
+ Ability to manage various sources of information and large data sets including pharmacy, claims and encounter data
+ Proficiency in compiling data, creating reports and presenting information, including knowledge of Power BI Reports (or similar reporting tool), SQL query, MS Access and MS Excel
+ Ability to combine clinical and financial data
+ Demonstrated ability to meet established deadlines
+ Ability to function independently and manage multiple projects
+ Ability to develop scenario analysis using different approaches
+ Ability to present ideas and information concisely to varied audiences
+ Proficiency with PC-based systems, and the ability to learn other systems through knowledge of MS Excel and AccessExcellent verbal and written communication skills
+ Ability to quickly assimilate knowledge of processes and systems to develop and deliver necessary training to departmental staff and internal customers
+ Ability to work in a deadline driven department
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Basic knowledge of SQL
+ Preferred Education
+ Bachelor's Degree in Finance, Economics, Math, or Computer Science
**Preferred Experience**
+ Multiple data systems and models
+ Complex database and data management responsibilities
+ Claims processing background
+ Configuration background
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: $63,133 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
2
Project Manager, PMO - Healthcare
42102 Bowling Green, Kentucky
Molina Healthcare
Posted 1 day ago
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach(as). Solid knowledge of methods and techniques involved in project management initiatives.
+ Work with IT and business teams to set up/ amend new/ existing healthplans and new lines of business.
+ Must have experience in merger and acquisitions
+ Familiarity with SDLC.
+ Must have strong experience in Jira and smartsheets is preferred
+ Knowledge in Medicare, Medicaid and Marketplace is highly preferred.
+ Able to develop detailed project plans, communication plans, schedules, role definition, risk management and assumptions.
+ Complete mastery of standard applications and project specific software. Able to learn new software with little to no instruction within a short timeframe and instruct others on its functionality.
+ Identifies problems and anticipates potential problems. Ability to present alternatives to manage/overcome obstacles.
+ May consultant with higher level project management staff and may refer to established procedures and/or prior experience to determine appropriate and timely action. Projects may have moderate cross functional impact and team organization.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's degree or equivalent combination of education and experience and at least 1 PM course required
**Required Experience**
2-4 years of relevant work experience in business, engineering, or a related field in lieu of degree acceptable.
**Preferred Education**
Additional formal training in PM preferred.
**Preferred License, Certification, Association**
PMP or Six Sigma Green Belt Certification desired.
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: $77,969 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach(as). Solid knowledge of methods and techniques involved in project management initiatives.
+ Work with IT and business teams to set up/ amend new/ existing healthplans and new lines of business.
+ Must have experience in merger and acquisitions
+ Familiarity with SDLC.
+ Must have strong experience in Jira and smartsheets is preferred
+ Knowledge in Medicare, Medicaid and Marketplace is highly preferred.
+ Able to develop detailed project plans, communication plans, schedules, role definition, risk management and assumptions.
+ Complete mastery of standard applications and project specific software. Able to learn new software with little to no instruction within a short timeframe and instruct others on its functionality.
+ Identifies problems and anticipates potential problems. Ability to present alternatives to manage/overcome obstacles.
+ May consultant with higher level project management staff and may refer to established procedures and/or prior experience to determine appropriate and timely action. Projects may have moderate cross functional impact and team organization.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's degree or equivalent combination of education and experience and at least 1 PM course required
**Required Experience**
2-4 years of relevant work experience in business, engineering, or a related field in lieu of degree acceptable.
**Preferred Education**
Additional formal training in PM preferred.
**Preferred License, Certification, Association**
PMP or Six Sigma Green Belt Certification desired.
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: $77,969 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
3
Sr. Program Manager - Healthcare Enrollment (Remote)
42102 Bowling Green, Kentucky
Molina Healthcare
Posted 1 day ago
Job Viewed
Job Description
**Job Summary**
Responsible for multiple Enrollment internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as review enhancement ROI. Candidate must have strong analytic, organizational skills and the ability to independently resolve issues and remove hurdles. This is a hybrid role that requires Program Management, System Analyst and Sr. Business Analyst skills. Responsibilities include troubleshooting, analyzing, managing assignments, assisting team members, oversight of vendor projects, reviewing team outputs, review of deployment request and post deployment monitoring.
Building and maintaining strong relationships and proactive processes are key to the success of this team. The selected candidate would act as the liaison between the business, vendors , IT, and support Program Managers and Business Analyst in a subject matter expert capacity. May engage and oversee the work of external vendors. Coordinates with business analyst, IT and business areas, provides and reviews requirements and test results.
Knowledge/Skills/Abilities
+ Independently manage and deliver Enrollment Enterprise wide project initiatives from inception through delivery
+ Subject matter expert of enrollment to Program Managers and Analyst and in functional areas (Inbound and Outbound)
+ Communicate and collaborate with Operations, Health Plans and Leadership to analyze and transform needs and goals into functional requirements
+ Develops, defines, and executes plans, schedules, and deliverables. Monitors programs from initiation through delivery
+ Identify root cause, function and process improvement opportunities that are critical to effective outcome
+ Leads programs to meet critical needs. Including but not limited to BRD reviews, logic changes, root cause analysis, etc.
+ Works with operational leaders within the business to provide recommendations on opportunities for process improvements
+ Collaborate with Other Teams within Molina to deliver End to End for any process within Enrollment Accounting Team
+ Active collaborator responsible for operation projects and programs involving enrollment and eligibility
+ Works with cross-functional teams and IT and business subject matter expert and to deliver products from design to completion
+ Subject matter expert of enrollment and provides knowledge and feedback to ensure regulatory and Addresses health plan concerns within Enrollment Operations
+ Researches, interpret, define and summarize enhancement recommendations
+ Provides health plan requirement recommendations
+ Responsible for managing deliverables, improving performance, training needs, support to other business units
+ Strong business knowledge related to Medicaid and Medicare lines of business
+ Reviews enrollment issue trends and provides long term solutions as needed
+ Manages, creates and communicates status reports
+ Ensures compliant with regulatory and company guidelines, including HIPAA compliance
+ This position primarily focuses on project/program management related to the business projects, rather than the technical application projects
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business
+ Participate and lead brainstorming sessions to develop new concepts to build efficiencies
+ Ideally possess minimum of 5 years' experience with eligibility processing, including; eligibility Applications and Files
+ Extensive knowledge in health insurance
+ Knowledge of enrollment files, including extracts
+ Program Manager experience
+ Sr. Business or System Analyst experience
+ Process Improvement Experience.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
7-9 years
**Required License, Certification, Association**
PMP Certification (and/or comparable coursework)
**Preferred Education**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience**
10+ years
**Preferred License, Certification, Association**
Six Sigma Black Belt Certification, ITIL Certification desired
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: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Responsible for multiple Enrollment internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as review enhancement ROI. Candidate must have strong analytic, organizational skills and the ability to independently resolve issues and remove hurdles. This is a hybrid role that requires Program Management, System Analyst and Sr. Business Analyst skills. Responsibilities include troubleshooting, analyzing, managing assignments, assisting team members, oversight of vendor projects, reviewing team outputs, review of deployment request and post deployment monitoring.
Building and maintaining strong relationships and proactive processes are key to the success of this team. The selected candidate would act as the liaison between the business, vendors , IT, and support Program Managers and Business Analyst in a subject matter expert capacity. May engage and oversee the work of external vendors. Coordinates with business analyst, IT and business areas, provides and reviews requirements and test results.
Knowledge/Skills/Abilities
+ Independently manage and deliver Enrollment Enterprise wide project initiatives from inception through delivery
+ Subject matter expert of enrollment to Program Managers and Analyst and in functional areas (Inbound and Outbound)
+ Communicate and collaborate with Operations, Health Plans and Leadership to analyze and transform needs and goals into functional requirements
+ Develops, defines, and executes plans, schedules, and deliverables. Monitors programs from initiation through delivery
+ Identify root cause, function and process improvement opportunities that are critical to effective outcome
+ Leads programs to meet critical needs. Including but not limited to BRD reviews, logic changes, root cause analysis, etc.
+ Works with operational leaders within the business to provide recommendations on opportunities for process improvements
+ Collaborate with Other Teams within Molina to deliver End to End for any process within Enrollment Accounting Team
+ Active collaborator responsible for operation projects and programs involving enrollment and eligibility
+ Works with cross-functional teams and IT and business subject matter expert and to deliver products from design to completion
+ Subject matter expert of enrollment and provides knowledge and feedback to ensure regulatory and Addresses health plan concerns within Enrollment Operations
+ Researches, interpret, define and summarize enhancement recommendations
+ Provides health plan requirement recommendations
+ Responsible for managing deliverables, improving performance, training needs, support to other business units
+ Strong business knowledge related to Medicaid and Medicare lines of business
+ Reviews enrollment issue trends and provides long term solutions as needed
+ Manages, creates and communicates status reports
+ Ensures compliant with regulatory and company guidelines, including HIPAA compliance
+ This position primarily focuses on project/program management related to the business projects, rather than the technical application projects
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business
+ Participate and lead brainstorming sessions to develop new concepts to build efficiencies
+ Ideally possess minimum of 5 years' experience with eligibility processing, including; eligibility Applications and Files
+ Extensive knowledge in health insurance
+ Knowledge of enrollment files, including extracts
+ Program Manager experience
+ Sr. Business or System Analyst experience
+ Process Improvement Experience.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
7-9 years
**Required License, Certification, Association**
PMP Certification (and/or comparable coursework)
**Preferred Education**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience**
10+ years
**Preferred License, Certification, Association**
Six Sigma Black Belt Certification, ITIL Certification desired
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: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
Be The First To Know
About the latest Healthcare Jobs in Morgantown !
4