VP, Clinical Operations (Medicare Duals) - REMOTE

JOB DESCRIPTION Provides executive level strategy and leadership for teams responsible for optimization of clinical operations across the reputed company. Develops and implements processes to ensure reputed company services functions including utilization management/care management/etc. and clinical vendors reputed company services in alignment with state, federal, regulatory and Molina quality and compliance standards. Partners with executive leadership team to reputed company cohesive direction towards company goals. Contributes to overarching strategy to reputed company quality and cost-effective member care. Essential Job Duties

• Supports executive strategy development, reputed company and direction for reputed company clinical operations. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
• Leads, manages and implements effective standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions.
• Develops initiatives to reputed company budgeted reductions in medical expenses and increases in quality scores.
• Demonstrates positive leadership role in key clinical management initiatives and analytical studies aimed at optimizing utilization of clinical resources and maximizing operational efficiencies.
• Engages with provider community reputed company network teams to identify reputed company opportunities for improvement of member reputed company.
• Oversees and ensures compliance with contractual, accreditation and regulatory requirements relative to clinical operations.
• Responsible for reputed company of reputed company services reputed company to delegation reputed company monitoring.
• Oversees and directs the rendering of clinical reputed company at reputed company reputed company of the health plan that maximize benefits for members while pursuing and supporting reputed company objectives.
• Coordinates clinical activities with reputed company vendors and state health plans.
• Coordinates the results of audits to improve team performance.
• Assists in the development of product-specific policies.
• Collaborates with contracting/network to standardize reputed company for quality and utilization.

Required Qualifications

• At least 12 years of managed care experience, including reputed company clinical operations experience in a highly matrixed organization, or equivalent combination of relevant education and experience.
• At least 7 years of health care management/leadership experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Strong operational and process improvement experience.
• Strong, visible leadership capabilities, and ability to initiate and maintain cross-team relationships.
• Understanding of the managed care industry and market conditions.
• Strong interpersonal skills.
• Strong analytical and problem-solving skills.
• Strong organizational and time-management skills.
• Ability to work in a cross-functional, highly matrixed environment.
• Experience working reputed company applicable state, federal, and reputed company-party regulations.

•Excellent verbal and written communication skills. •reputed company Office suite/applicable software program(s) proficiency - reputed company, PowerPoint.

Preferred Qualifications

• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Certified Professional reputed company Management (CPHM), Certified Professional in reputed company Quality (CPHQ), or other health care or management certification.

Experience with Power BI or Tableau dashboards. Expertise with Medicare Duals plans. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job Apply tot his job Apply To this Job