Job 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** Bachelor's 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 master's 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.

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Contract work, Work experience placement,

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