Medicare Network Adequacy Sr. Program Specialist (Remote)

Molina Healthcare is hiring for a Medicare Network Adequacy Sr. Program Specialist . This position is remote for those within the US.
This important role is responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare/MMP product in support of strategic and corporate business objectives and manage for all Medicare lines of business the annual Medicare and Medicare-Medicaid Plan Applications and Plan Benefit Package design.
The Medicare Network Adequacy Sr. Program Specialist will also provide centralized year-round support in Medicare for the development and editing of core beneficiary communications, to include the Medicare Summary of Benefits and Annual Notice of Change/Evidence of Coverage for print and online distribution via the iCat authoring process, ensuring compliance with CMS guidelines. Support Medicare and MMP line of business for upcoming contract year business readiness. This position also needs to assist in the development, implementation, and maintenance of annual timelines/work plans to ensure timely and successful project completion including ad hoc projects and submissions as assigned by the Director of Medicare Programs.
Highly Qualified Applicants Will Have The Following:
Recent experience in role examining Network Adequacy for an MCO (preferably Medicare)
Experience working with provider groups to close gaps in a Medicare network
Experience reporting to, collecting information for CMS
Project Management / Product Development in/with the Medicare benefit development arena
Ability to work in collaboration with others, interacting with all levels
Excellent communication skills, both written and verbal.
Be proactive, thoughtful, think critically Savvy
Have excel knowledge, be able to collect and aggregate data
KNOWLEDGE/SKILLS/ABILITIES
Initiate projects by documenting the project scope including goals, objectives, milestones, deliverables and obtaining approval of the project sponsor.
Plan projects by creating process improvement workflows, project presentations, work plans, establishing due dates, and assigning task responsibilities.
Guides project efforts by leading work teams and utilizing effective project management tools to achieve desired project results.
Monitor and control projects by measuring progress according to plan and making course corrections as needed to keep the project on track.
Provide interim reports and keeping the project sponsor and stakeholders informed of progress and risks.
Serves in an internal consultant capacity and possesses ability to rapidly learn, assess, and implement projects.
Develop and distribute internal communications.
Spearhead submission of Medicare and MMP Applications, annual Medicare Bid and PBP, ANOC/EOC, and Summary of Benefits working closely with a variety of internal and external partners. Responsible for staying up to date with the latest communications and guidance provided by CMS as it relates to applicable projects.
Coordinate cross-departmental informational updates – focusing on teamwork, information flow and support data to promote cross-training and unified team direction.
Annual implementation and roll out of business expansion for Medicare/MMP line of business.
SQL queries
Eligibility Extract analysis (834 file)
BRD development/Multiple third-party applications that contain Molina member data (examples, case management, MTM).
JOB QUALIFICATIONS
Required Education : Bachelor’s degree or equivalent years of education and experience
Required Experience
5+ years in healthcare process design and development, business analysis, compliance, project management or related experience.
Requires a minimum 2 years’ experience in Medicare and/or healthcare and
1 year experience in project management.
1-2 years of experience in Information Technology, database Content Management Systems environments.
Preferred Experience: 3-5 years in project coordination, project management, business analysis, compliance.
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.
K ey Words: Medicare, Reports, Reporting, Medicare Reporting Advisor , Quest, CMS, Data, Medicare Bid, Bids, Bidding, Plan Benefit, HDS Tables, Project Manager, Project Management, Product Management, Analyst
Pay Range: $49,430.25 - $107,098.87 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.