Provides subject matter expertise and leadership for compliance activities. Seeks to ensure the organization adheres to regulatory requirements, industry standards, and Molina internal policies, and prevents and/or detects violation of applicable laws and regulations, and protect the business from liability, fraudulent or abusive practices.
Essential Job Duties
• Key contributor in ensuring that the business understands and complies with applicable laws and regulations pertaining to the health care environment, and ensures business accountability for compliance by overseeing, following-up and resolving investigations.
• Assists with implementation and day-to-day operations of the compliance program, compliance plan, code of conduct, and fraud, waste and abuse (FWA) plan across the enterprise, and ensuring compliance with governmental requirements.
• Spearheads development and implementation of compliance policies and procedures, and training programs for the Molina enterprise.
• Oversees and provides direction of site visits for regulatory audits, and coordinates corrective action plans (CAPs), as necessary.
• Investigates and resolves compliance issues, inquiries, or complaints received internally or from customers/agencies.
• Provides input and representation on key compliance initiatives, meetings, and committees.
• Stays abreast of industry and compliance trends, and recommends and implements changes to internal company processes as needed.
Job Requirements
• At least 5 years of experience in compliance, risk management, and/or auditing, or equivalent combination of relevant education and experience.
• Strong knowledge of relevant regulatory frameworks and industry standards.
• Experience developing and implementing compliance programs.
• Ability to thrive in a cross-functional highly matrixed environment.
• Strong analytical and problem-solving skills.
• Project management experience.
• Ability to build rapport and gain the respect and collaboration of internal/external stakeholders.
• Knowledge and ability to think creatively, proactively, and independently.
• Ability to prepare reports and presentations, and manage data.
• Self-motivated and results oriented.
• Strong organizational skills and the ability to meet delivery targets.
• Disciplined and ability to effectively track, document and report on projects/activities.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.
Preferred Qualifications
• Previous experience in a health plan or government programs setting (Medicaid, Medicare, Marketplace).
• Certificate in Healthcare Compliance (CHC), or other compliance-related certification.
• The ideal candidate should be willing to work PST hours as this supports Molina's Washington health plan.
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
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.
Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
