USACares Jobs

Job Information

Molina Healthcare Dir, Applications_MHI IT-Member Claims Mgt_0100444520_MEEKER in Long Beach, California

Job Description

Job Summary:

The Director, IT –Claims Systems is responsible for providing Information Services and Technology leadership to understand and align IT systems, software, architecture, resources, and projects, to support the strategic and business goals of Molina and deliver successful outcomes to Molina members.

The position’s essential functions:

• Execute on the vision and guiding principles necessary to establish goals, and action plans for IT Claims Systems function.

• Understand the nuances of the business to drive continuous improvement of the efficiency of, effectiveness of, and satisfaction with the people, processes, and technologies in your functional area.

• Establish and track detailed metrics based on business objectives and strategic goals.

• Establish and foster key relationships with service providers and be a trusted advisor for the Business Stakeholders.

• Support efforts to identify and support the development of new capabilities in people, process, and technology.

• Staff and support Business and IT initiatives, projects, and programs.

• Continuously improve effectiveness, efficiency and customer satisfaction (internal and external customers).

• Ensure corporate governance is managed according to corporate guidelines for IT and Business functions.

• Develop, educate, and enforce IT policies and procedures that improve stability, efficiency, accuracy, quality, and availability of IT systems and functions within your area.

• Manage and develop talent within the organization. Provide leadership and mentoring to team members and develop new leaders and successors.

General Knowledge:

• Knowledge of operational governance processes of the IT and business organization.

• Knowledge of the development of applications and technology to support the company’s goals.

• Knowledge of risk management, resource allocation, and project prioritization.

• Knowledge of research and recommendation of new systems, software, and services.

• Knowledge of IT and software Architecture, Design, Development, Implementation, Release Management, Incident & Problem Management, as well as Support & Maintenance of business applications and systems.

• Knowledge of industry standard technology, tools, benchmarks, applications, and/or project delivery methodology.

• Knowledge of Healthcare IT claims processing systems, including how to manage and control access to PHI in a Healthcare IT environment.

Functional Knowledge:

• Ability to oversee day-to-day management of a technical team, consisting of local and remote employees as well as a large number of onshore and offshore contract resources.

• Ability to collaborate with the business management team both with the centralized corporate business functions as well as the state level health plan to achieve the successful outcomes aligned with the Molina business strategy.

• Ability to participate in technology planning. Drive the implementation of development best practices throughout the organization, while governing control and ensuring objectives are achieved.

• Ability to participate IT operational planning to achieve business goals by fostering innovation, prioritizing IT initiatives, and coordinating the evaluation, deployment, and management of current and future IT systems across the organization.

• Ability to establish team goals, objectives, and operating procedures. Establish lines of control for current and proposed information systems.

• Ability to ensure IT claims system operation complies with applicable laws and regulations.

• Ability to manage maintenance and professional services contracts.

• Ability to source and manage vendor partners.

• Ability to act as an advocate for the organization’s IT vision via regular written and in-person communications with the organization’s department heads, and business users.

• Ability to assess and communicate risks associated with IT projects, operations, and support activities.

• Ability to develop business case justifications and cost/benefit analyses for team spending.

• Ability to consult with stakeholders to define business and systems requirements for new technology and process implementations.

• Ability to ensure continuous delivery of IT services through oversight of service level agreements with end users and monitoring of IT systems performance.

• Ability to approve, prioritize, and control projects and the project portfolio as they relate to the selection, acquisition, development, and installation of major information systems.

Leadership Knowledge:

• Ability to collaborate and provide leadership, exhibiting dedication to Molina’s mission, modeling, embodying and advocating Molina’s core competencies, values and leadership behaviors.

• Ability to create and develop new systems and models by making tough, data-driven decisions without prejudice, accepting, and acting on, facts.

• Ability to engage, coach, evaluate, influence and motivate others, providing frequent feedback and positive reinforcement.

Job Qualifications

Required Education:

BA/BS in Computer Science/ Information Technology/Business Administration or equivalent experience.

Preferred Education:

Master’s Degree in Management or Information Systems or equivalent experience.

Required Experience:

• Minimum of 5 years of experience in key IT management positions.

• Excellent supervisory and leadership skills.

• Advanced knowledge of Managed Care operations and business processes and services related to state and federal laws and regulations.

• Experience with Cognizant TriZetto QNXT platform.

• 7+ years of application design and development experience.

Preferred Experience:

• Managed Healthcare.

• Experience hosting applications in Azure.

Preferred Licensure/Certification/Associations:

• ITIL, PMP

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.

DirectEmployers