Job DescriptionJob Description
Responsible for 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 and Sr. Business Analyst skills. Additional responsibilities include troubleshooting, analyzing, project managing assigned issues to resolution, review of redeployment 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 and IT and would support Program Managers 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.
Manage and deliver Enrollment Enterprise wide project initiatives from inception through delivery.
Subject matter expert of enrollment to Program Managers and in functional areas (Inbound and Outbound)
Communicates and collaborates with customers 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 and communicates status for 20-30 assignments
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
Reviews, and approves test cases for assignments
Bachelor's Degree or equivalent combination of education and experience
Candidate needs 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
Graduate Degree or equivalent combination of education and experience
Knowledge related to enrollment & eligibility, ID cards, PCP Assignment, Member Materials
Knowledge of CMS regulations
Preferred License, Certification, Association
PMP Certification (and/or comparable experience), 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.