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Job Description

Job Summary

The Dir, Delegation Oversight oversees and manages the Delegation Oversight team(s) responsible for coordinating delegated vendor activities between contracted entities and Molina Healthcare. This includes claims, contact center, credentialing, appeals and grievances, care management, utilization management, pharmacy, and other operational functions across multiple states and lines of business. Responsibilities include onboarding, performance management, auditing, monitoring, and risk mitigation to ensure service delivery by delegated vendors in accordance with contract terms. Audits, oversees, and monitors delegated vendors’ compliance with state and federal regulatory requirements.

Job Duties

Strategic Direction and Collaboration:

• Set the strategic direction, mission, and vision for Molina’s delegation oversight responsibilities and partnership

• Collaborate with internal business partners to develop criteria and best practices for delegated vendor selection, oversight, and management

Negotiation and Compliance:

• Participate in the negotiation process of delegated service level agreements and addendums. Ensure contractual obligations are achieved and initiate contract changes when required

• Provide assistance to strategic sourcing, national network, and health plan teams to optimize the cost-effectiveness of negotiations and ensure compliance with regulatory requirements

Performance Management and Other Requirements:

• Expert in reviewing and communicating requirements related to delegated functions for clarity and minimizing change requests

• Develop, implement, and manage reporting of metrics and Service Level Agreements that effectively measure team and vendor performance in line with business needs and regulatory compliance

Business and Regulatory Understanding:

• Deep understanding of business and regulatory requirements, deliverables, processes, and technologies impacting delegated agreements

• Manage delegated vendor contracts as they relate to specific functions, oversee regulatory requirements, and manage related governance committees, reporting to other applicable committees (e.g., Quality)

Vendor Relationship Management:

• Manage delegated vendor relationships as the key point of contact between specified vendors and the business

• Serve as a point of escalation for delegated vendor issues and risks, driving those issues to resolution

• Optimize delegated vendor relationships through contract management compliance, quantitative analyses, and relationship management, creating mutually beneficial opportunities

Tools and Data Management:

• Maintenance of tools or delegation oversight relationships, including delegated vendor tracking, analytics, and performance management

• Manage the collection, consolidation, and communication of reporting and data on delegated vendor contracts, performance, risk, and relationships to key stakeholders and vendors

Performance Management:

• Manage the performance of national and state delegated vendors, ensuring compliance with contractual and regulatory requirements

• Manage the national delegation oversight performance management team

Auditing and Oversight:

• Manage required audits for national and state delegated vendors, ensuring compliance with contractual and regulatory requirements

• Manage national and state delegation oversight audit teams

• Collaborate with Molina Quality Department on NCQA external audits, ensuring compliance with accreditation standards for applicable national and state delegated vendors

Job Qualifications

REQUIRED QUALIFICATIONS:

• Graduate Degree or equivalent combination of education and experience

• 8+ years of experience in Healthcare, Vendor Management, Delegation Oversight, Compliance and Oversight

• Prior contract management experience

• Must be detail oriented and have strong negotiating skills, must be able to multitask effectively, possess strong analytical, problem solving, decision making and people management skills

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: $107,028 - $208,446 / ANNUAL

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