Job Description

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