Molina Healthcare

Lead clinical operations and enterprise performance, overseeing compliance, audits, workforce strategy, vendors, and clinical insights to improve member outcomes. | Requires 12+ years of managed-care experience and progressive clinical-operations leadership; a professional certificate is listed, with clinical licensure required only where mandated. | JOB DESCRIPTION Job Summary Provides enterprise executive leadership for clinical operations, ensure Utilization Management, Care Management, Long-Term Services and Supports, quality, workforce, vendor, and delegated functions achieve regulatory compliance, operational excellence, financial performance, and high-quality member outcomes. Oversees centralized clinical audits and reporting, Clinical HEDIS/Stars strategies and performance, clinical workforce and staffing strategy, clinical vendor and delegation accountability, clinical model-office governance, technology-related productivity re-baselining, and clinical data and insights. Partners with executive leaders, health plans, and business segments to standardize performance, drive continuous improvement, and deliver scalable, cost-effective care. Work Location - Remote within the United States Essential Job Duties Provides executive oversight for operational performance for clinical Utilization Management (UM), Care Management (CM), and Long-Term Services and Supports (LTSS) audit programs.  Leads and manages a centralized clinical audit team that drives enterprise standardization, audit readiness, regulatory and contractual compliance, corrective action planning, sustainable performance improvement, and consistent performance reporting to health plans and business segments.   Provides executive leadership for clinical workforce management, including staffing strategy, capacity and demand planning, productivity and performance oversight, workforce analytics, talent development, and alignment of clinical resources with operational, financial, and member-care objectives.    Drives enterprise strategies for clinical HEDIS/Stars measures, including quality performance, measure optimization, care-gap closure, data integrity, regulatory compliance, cross-functional accountability, and continuous improvement to achieve quality, member outcome, and performance objectives.    Provides executive oversight of clinical vendor and delegated entity performance, including governance, service-level, quality, financial, and compliance monitoring; evaluation of contractual and regulatory requirements; identification and remediation of performance gaps; and accountability for outcomes aligned with enterprise and member-care objectives.   Leads the clinical model office in developing and refining standardized staffing models and time-study methods based on acuity, workload, productivity, skill mix, and service demand; validates assumptions, sets productivity benchmarks, and drives scalable, efficient, high-quality clinical operations.     Partners with Enterprise Information Management, Medical Economics, and Finance to provide the Clinical COE with reliable data, standardized reporting, performance analytics, and actionable insights that improve clinical quality, operational efficiency, financial performance, and member outcomes.  Travel - As needed, approx. 25%   Required Qualifications • At least 12 years managed care experience, including progressive clinical operations experience in a highly matrixed organization, or equivalent combination of relevant education and experience. • At least 7 years 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 within applicable state, federal, and third party regulations. • Excellent verbal and written communication skills.  • Microsoft Office suite/applicable software program(s) proficiency.   Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.   To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Lead end-to-end program delivery and governance across cross-functional units to drive performance and alignment. | 6+ years program/project management experience in regulated environments with strong data analysis and communication skills. | JOB DESCRIPTION Job Summary Provides subject matter expertise and leadership for program management activities.  Supports programmatic business needs across department and/or cross-functional areas, including programs design, implementation, administration, governance, workflow analysis, process improvements, vendor management, policy and playbook development and maintenance, best practices, resource allocations and special projects.   Essential Job Duties • Manages the design, implementation, delivery, and ongoing operations of respective business program(s) and services. • Leads end-to-end program delivery by establishing goals, scope, and success measures aligned with organizational priorities. • Develops and maintains governance frameworks to ensure consistent, compliant, and effective program management practices. • May oversee financial stewardship of program budgets - ensuring proper prioritization and alignment of resources to achieve desired outcomes. • Partners with executive sponsors and functional leaders to ensure program objectives are met and value is realized across business units. • Drives performance measurement and reporting, including dashboards, key performance indicators (KPIs), and post-implementation reviews to track outcomes and identify opportunities for continuous improvement. • Ensures well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program(s).   • Collaborates with legal, compliance, information technology (IT), and other cross-functional teams to ensure governance standards are upheld. • Tracks performance metrics and ensures value realization from deployed solutions.  • Coordinates recurring meetings to support governance framework and decision-making processes. • Oversees portfolio management and/or initiative-specific programmatic changes and project management. • Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices, etc. • Routinely reviews program collateral to ensure current and accurate reflection of business needs.   • Promotes consistency in planning, communication, and execution across initiatives. • Champions organizational change management by ensuring effective stakeholder engagement, communication, and adoption of new processes or technologies. • Maintains and evolves program documentation, playbooks, and best practices to reflect current business needs and lessons learned. • Identifies opportunities/gaps and provides recommendations on program enhancements to applicable leaders.  • Creates business requirements documents (BRDs), test plans, requirements traceability matrices, user training materials and other related documentation. • Generates and distributes required business/programmatic reporting. • Facilitates special functional/departmental projects. • May provide specialized training and support to new and existing staff as needed.   Required Qualifications • At least 6 years of progressive program and/or project management experience, with increasing levels of responsibility in a complex, matrixed organization, or equivalent combination of relevant education and experience. • Proven experience leading large-scale or multi-functional programs within healthcare, managed care, or a similar regulated environment. • Strong operational process improvement and change management experience. • Advanced project management experience/skills. • Data analysis skills/experience. • Strong organizational and time-management skills. • Proven ability to manage multiple projects simultaneously with competing priorities. • Experience managing budgets and resource plans for business/strategic initiatives. • Ability to work cross-collaboratively across a highly matrixed organization. • Strong verbal/written/presentation communication skills, and ability to influence at all levels of the organization. • Advanced Microsoft Office suite (including Excel, PowerPoint, Project, and Visio), and applicable software programs proficiency.   Preferred Qualifications Experience with Jira, SharePoint, Smartsheet, and other project or portfolio management tools. Project Management Professional (PMP) and/or Six Sigma Green Belt certification. Health care/managed care experience.   To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Provide senior-level support for enterprise infrastructure, including cloud environments, automation frameworks, and system reliability. | At least 5 years IT engineering experience, bachelor's degree, proficiency in scripting, cloud platforms like Azure, and monitoring tools. | JOB DESCRIPTION Job Summary Provides senior level engineering support for enterprise infrastructure systems through contributions to the implementation, maintenance, and reliability of platforms that enable critical business services across compute, storage, networking, cloud, and automation technologies. Collaborates with engineers, architects, and cross-functional teams to drive system design, deployment, and operations throughout the technology lifecycle.  Leverages infrastructure and security expertise to troubleshoot complex issues, optimize performance, and ensure solutions meet evolving business and technical requirements.   Essential Job Duties • Supports and enhances enterprise information systems (EIS) and infrastructure technologies across compute, storage, networking, database, and hybrid cloud environments, including Azure services and automation. • Serves as a senior technical specialist for infrastructure platforms, systems technologies, cloud services, and automation frameworks. • Provides advanced scripting and automation support using PowerShell, Python, and infrastructure‑as‑code tools (such as Terraform) to improve efficiency, consistency, and scalability. • Builds strong relationships with IT leadership, engineers, program managers, support leads, and external vendors to understand requirements and deliver technical solutions. • Contributes to strategic planning of architecture standards, roadmaps, budgets, programs, and projects, and provides senior‑level technical input. • Facilitates and reviews technical design solutions, documentation requirements, and engineering standards across department functions. • Leads and executes complex build, deployment, and configuration activities across infrastructure platforms. • Ensures IT system implementations align with licensing, design, security, and compliance requirements, and provides guidance to engineering teams. • Supports and enhances monitoring, alerting, and observability tools (e.g., Splunk, Dynatrace, SolarWinds) to maintain system health, performance, and resiliency. • Supports security controls, patching, vulnerability remediation, and compliance requirements (HIPAA, HITECH), and provides technical guidance on remediation strategies. • Collaborates with networking, security, and application teams to ensure integrated, end‑to‑end service delivery and cross‑platform alignment. • Follows and reinforces project methodologies and change‑management processes to ensure compliant and consistent delivery. • Contributes to solution‑architecture delivery within project methodologies, timelines, and governance frameworks, and provides senior‑level technical recommendations. • Performs advanced root‑cause analysis, troubleshooting, and problem‑solving to resolve complex infrastructure and service issues and address IT‑related business challenges. • Leads or contributes to cross‑team project tasks, engineering deliverables, and technical workstreams. • Develops and presents technical solutions, engineering recommendations, and design considerations for peer‑review committees. • Shares technical concepts, best practices, and solutions with technical peer audiences and mentors junior engineers. • Participates in on‑call rotation schedules and off‑hours support activities, including escalation support for complex issues. • Ensures adherence to IT process controls, including incident, change, and configuration management, and contributes to process improvements. • Provides training and support to new and existing EIS team members, and constructive feedback to improve people, processes, and technology across the organization.   Required Qualifications • At least 5 years of information technology (IT) engineering or infrastructure support experience, or an equivalent combination of relevant education and experience. • Bachelor's degree in IT, computer science, statistics, business, health care, engineering, etc. • Understanding of IT architecture concepts, enterprise infrastructure components, and the software development lifecycle (SDLC).   • Experience working with enterprise information systems (IS), platforms, or infrastructure technologies. • Knowledge of health care payer processes/industry/trends and related regulatory requirements. • Ability to execute data queries and analysis to support troubleshooting and fact-based decision-making. • Analytical (including data analysis), critical‑thinking, and problem‑solving skills. • Planning and process design/improvement experience. • Effective organizational and time-management skills. • Ability and initiative to learn new technologies quickly, including cloud, automation, and monitoring tools. • Project management experience.  • Ability to collaborate cross-functionally in a highly matrixed organization, and influence stakeholders on scalable solutions. • Exposure to hybrid cloud environments (Azure), scripting (PowerShell/Python), or infrastructure‑as‑code tools (Terraform). • Familiarity with monitoring/observability tools (Splunk, Dynatrace, SolarWinds) and basic security practices such as patching or vulnerability remediation. • Effective verbal/written/interpersonal communication skills. • Microsoft technology stack (including advanced Excel), and SQL proficiency.   Preferred Qualifications • Managed care experience, including knowledge of health care payer systems, standards, and protocols. • Understanding of health care industry regulations and compliance requirements (e.g., HIPAA, HITECH). • Experience with Azure Cloud (or other cloud platforms), virtualization technologies, Windows/Linux systems, enterprise networking concepts, and enterprise platforms such as PEGA and Salesforce. • Proficiency with PowerShell, Python, and Terraform for automation and infrastructure design. • Experience contributing to architecture reviews, engineering standards, or modernization initiatives.     To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Provide senior-level engineering support for enterprise infrastructure systems including compute, storage, networking, cloud, and automation technologies. | At least 5 years IT engineering experience with skills in Azure, PowerShell, Python, Terraform, monitoring tools, and security practices. | Job Description JOB DESCRIPTION Job Summary Provides senior level engineering support for enterprise infrastructure systems through contributions to the implementation, maintenance, and reliability of platforms that enable critical business services across compute, storage, networking, cloud, and automation technologies. Collaborates with engineers, architects, and cross-functional teams to drive system design, deployment, and operations throughout the technology lifecycle. Leverages infrastructure and security expertise to troubleshoot complex issues, optimize performance, and ensure solutions meet evolving business and technical requirements. Essential Job Duties • Supports and enhances enterprise information systems (EIS) and infrastructure technologies across compute, storage, networking, database, and hybrid cloud environments, including Azure services and automation. • Serves as a senior technical specialist for infrastructure platforms, systems technologies, cloud services, and automation frameworks. • Provides advanced scripting and automation support using PowerShell, Python, and infrastructure-as-code tools (such as Terraform) to improve efficiency, consistency, and scalability. • Builds strong relationships with IT leadership, engineers, program managers, support leads, and external vendors to understand requirements and deliver technical solutions. • Contributes to strategic planning of architecture standards, roadmaps, budgets, programs, and projects, and provides senior-level technical input. • Facilitates and reviews technical design solutions, documentation requirements, and engineering standards across department functions. • Leads and executes complex build, deployment, and configuration activities across infrastructure platforms. • Ensures IT system implementations align with licensing, design, security, and compliance requirements, and provides guidance to engineering teams. • Supports and enhances monitoring, alerting, and observability tools (e.g., Splunk, Dynatrace, SolarWinds) to maintain system health, performance, and resiliency. • Supports security controls, patching, vulnerability remediation, and compliance requirements (HIPAA, HITECH), and provides technical guidance on remediation strategies. • Collaborates with networking, security, and application teams to ensure integrated, end-to-end service delivery and cross-platform alignment. • Follows and reinforces project methodologies and change-management processes to ensure compliant and consistent delivery. • Contributes to solution-architecture delivery within project methodologies, timelines, and governance frameworks, and provides senior-level technical recommendations. • Performs advanced root-cause analysis, troubleshooting, and problem-solving to resolve complex infrastructure and service issues and address IT-related business challenges. • Leads or contributes to cross-team project tasks, engineering deliverables, and technical workstreams. • Develops and presents technical solutions, engineering recommendations, and design considerations for peer-review committees. • Shares technical concepts, best practices, and solutions with technical peer audiences and mentors junior engineers. • Participates in on-call rotation schedules and off-hours support activities, including escalation support for complex issues. • Ensures adherence to IT process controls, including incident, change, and configuration management, and contributes to process improvements. • Provides training and support to new and existing EIS team members, and constructive feedback to improve people, processes, and technology across the organization. Required Qualifications • At least 5 years of information technology (IT) engineering or infrastructure support experience, or an equivalent combination of relevant education and experience. • Bachelor's degree in IT, computer science, statistics, business, health care, engineering, etc. • Understanding of IT architecture concepts, enterprise infrastructure components, and the software development lifecycle (SDLC). • Experience working with enterprise information systems (IS), platforms, or infrastructure technologies. • Knowledge of health care payer processes/industry/trends and related regulatory requirements. • Ability to execute data queries and analysis to support troubleshooting and fact-based decision-making. • Analytical (including data analysis), critical-thinking, and problem-solving skills. • Planning and process design/improvement experience. • Effective organizational and time-management skills. • Ability and initiative to learn new technologies quickly, including cloud, automation, and monitoring tools. • Project management experience. • Ability to collaborate cross-functionally in a highly matrixed organization, and influence stakeholders on scalable solutions. • Exposure to hybrid cloud environments (Azure), scripting (PowerShell/Python), or infrastructure-as-code tools (Terraform). • Familiarity with monitoring/observability tools (Splunk, Dynatrace, SolarWinds) and basic security practices such as patching or vulnerability remediation. • Effective verbal/written/interpersonal communication skills. • Microsoft technology stack (including advanced Excel), and SQL proficiency. Preferred Qualifications • Managed care experience, including knowledge of health care payer systems, standards, and protocols. • Understanding of health care industry regulations and compliance requirements (e.g., HIPAA, HITECH). • Experience with Azure Cloud (or other cloud platforms), virtualization technologies, Windows/Linux systems, enterprise networking concepts, and enterprise platforms such as PEGA and Salesforce. • Proficiency with PowerShell, Python, and Terraform for automation and infrastructure design. • Experience contributing to architecture reviews, engineering standards, or modernization initiatives. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Manage process improvement and organizational change projects within managed healthcare payer growth portfolio, including scheduling, costing, risk and issue management. | Bachelor's degree with project management coursework or 4-7 years experience; PMP or Six Sigma Green Belt preferred. | 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 * Deep understanding of effective project approach(es) for a variety of projects, including projects with a high degree of complexity spanning multiple areas. Able to organize complexity into successfully manageable work plans, estimate staffing requirements (e.g. resource skills & team assembly). * Expert knowledge of methods and techniques involved in project management initiatives. 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. * Proactively assesses projects for potential problem areas. Investigates, develops, and evaluates solutions to a wide range of complex problems spanning across multiple projects. processes, procedures, and tools to increase efficiency. Projects may have broad cross functional impact and team organization. JOB QUALIFICATIONS Required Education Bachelor's degree and at least 1 PM course required. Required Experience 4-7 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.

Implement health plan provider engagement strategies to improve quality and risk adjustment outcomes through data-driven coaching. | Requires 3+ years improving HEDIS quality scores and risk adjustment accuracy with data analysis proficiency. | JOB DESCRIPTION Job Summary Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes   Uses a consultative approach emphasizing physician engagement and behavior change through actionable data and analytics. Drives value-based care strategies through risk adjustment and quality improvement activities.  Ensures assigned Tier 1 & Tier 2 providers have engagement plans ensuring they meet annual quality and risk adjustment goals.  Drives coaching and collaboration with providers to improve performance through regular meetings and action plans.  Addresses practice environment challenges to achieve program goals and improve health outcomes.  Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives.    Essential Job Duties * Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives. * Ensures assigned Tier 1, Tier 2, and where applicable Tier 3, providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.  * Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.  * Works with provider front-office staff to get the Molina members with the most open gaps on the schedule and seen by their assigned provider. Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side. * Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.  * Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.  * Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness both within and across Molina health plans. * Serves as provider engagement subject matter expert; works collaboratively with health plan and shared service partners to ensure alignment to business goals.  * Collaborates with assigned health plan Provider Relations Network team member on operational, provider and member issues. * Accountable for use of standard Molina Provider Engagement reports and training materials.  * Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies. * Communicates comfortably and effectively with internal and external stakeholders, including physician leaders, providers, practice managers, and medical assistants within assigned provider practices. * Provides training and support for new and existing practice transformation and provider engagement team members. * Maintains the highest level of compliance. * May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.   Required Qualifications * At least 3 years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement, or equivalent combination of relevant education and experience. * Experience with various managed health care provider compensation methodologies including but not limited to:  fee-for service (FFS), value-based care (VBC), and capitation. * Working knowledge of quality metrics and risk adjustment practices across all business lines. * Knowledge and understanding of HEDIS/NCQA and/or CMS STARs quality measures and risk adjustment practices across Medicaid, Medicare and Marketplace. * Proficiency with data analysis, manipulation, interpretation and reporting. * Critical-thinking, problem-solving and analytical skills. * Relationship building skills. * Attention to detail and organizational skills. * Ability to implement process improvement initiatives and drive change. * Ability to work independently in a fast-paced, deadline-driven environment. * Ability to foster and build relationships in a cross-functional highly matrixed organization to obtain buy-in and drive results * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), Power BI, and other applicable software programs proficiency, and ability to learn new information systems and software programs. Preferred Qualifications *  Bachelor’s degree in Nursing, Health Administration or relevant discipline. * Solid understanding of health insurance, provider messaging/design and project management. * Strong experience using Microsoft products, including Excel (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint.     To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V