Job Description
Job Summary
Under the direction of the (TBD) , the Supervisor(s) oversees the development and implementation of the facilitated enrollment, Retention outreach and community engagement outreach of members within
the Individual Marketplace. This position supervises, coordinates and is accountable for the daily work of employees who provide facilitated enrollment services for Medicaid/Medicaid Managed Care (MA/MMC), Health and Recovery Plan (HARP) and Child Health Plus (CHP), and/or outreach activities. The position requires a systematic approach to identify opportunities for community and provider partnerships conducive to market growth. The Supervisor provides appropriate resources, coaching and assistance to the implementation and training needs of staff regarding rules and regulations, change management, productivity of individual and regional facilitated enrollment and outreach sales activities and/or retention program needs and activities. The Supervisor provides input on strategy as the business needs change within given territory.
Knowledge/Skills/Abilities
-Provides direction and supervision segment staff including departmental function, individual development plans, 1:1's, Quarterly Check-in's and performance reviews. Responsible for coordinating communication and daily activities of staff and assuring adequate staffing to accomplish corporate goals. Responsible for recruitment, training and retention of staff.
-Participates in strategic discussions with director, to ensure company goals are met; shifting to a more pro-active retention & sales approach, staying within company and state marketing guidelines.
-Fosters team culture during shift in strategy to help team work through changes.
-Takes lead in priority project(s) based on team (SWOT) Strengths/Weakness/Opportunity/Threat assessments within assigned segments (Customer Service. Facilitated Enrollment, Outreach or Retention) responsible for leadership, management, collaboration on assigned projects.
-Participates in the design and implementation of process improvements within the current (segment) facilitated enrollment policies, procedures, services and workflow to improve the customer experience and retention, as well as internal productivity.
-Ensures implementation and monitoring of new processes meet the New York State Department of Health (NYSDOH) rules and regulations of the programs, both current and new.
-Maintains Facilitator Enroller / SHOP annual recertification as outlined by NYSDOH.
-Monitors daily operations, identifies need for program tools, and works with management to meet staff needs.
-Manages the daily over-site of direct report staff input into (CRM) client relationship management system. Participates in the design/management of report methodologies that support facilitated enrollment services and the value of those services.
-Interacts with staff responsible for training, reporting, compliance, retention, enrollment, IT needs, and health plan management to assure that all functions of retention enrollment & customer service experience fit into the existing program structure. With special emphasis on community outreach techniques for those associated with these responsibilities.
-Maintains expert knowledge of current processes and rules and regulations of the MMC, HARP, EP & CHP, programs and serves as a resource for implementation, training teams, director of sales team.
-Ensures program processes are designed and implemented consistently across all regions and per department policies, procedures and guidelines. Facilitates quality and monitors results of the programs through quality indicators.
-Makes recommendations to leadership regarding corrective action plans and conducts other quality activities as directed by management. Activities include but are not limited to policy and procedure review, application reviews, and data collection and analysis related to current quality assurance indicators.
-Carries out job responsibilities in accordance with departmental, Health Plan, and state guidelines.
-Performs research assignments as directed by program leadership, which may include but are not limited to educational resources, best practice, corporate values and industry standards.
-Consistently demonstrates high standards of integrity by supporting Molina Healthcare of NY Inc. mission and values and adhering to the Corporate Code of Conduct and Leading to the Molina Healthcare of NY Inc.
-Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
-Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
-Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
-Regular and reliable attendance is expected and required.
-Performs other functions as assigned by management.
Additional Facilitated Enrollment Segment Responsibilities:
-Responsible for ensuring data collection, tracking and reporting for all appointment & facilitated enrollment activities are input into CRM by staff members in timely manner; conducts quality assurance activities with established process cadence.
-Anticipates and updates reporting requirements as needed.
-Represents team at multiple facilitated enrollment / compliance segment meetings on regular basis by region.
-Conducts quarterly announced / unannounced monitoring of staff; submits required monitoring paperwork and reports results including development recommendations to Director in a timely manner. Coordinates educational opportunities with director.
-Ability to travel to regional/staff and/or outreach efforts as assigned. In addition, attend quarterly on-site staff meeting and Adhoc organizational / department meetings.
Additional Community Engagement Outreach Segment Responsibilities:
-Represents team at multiple community engagement segment meetings on regular basis by region.
-Responsible for ensuring data collection, tracking and reporting for all Outreach activities are input into CRM by staff members in timely manner; conducts quality assurance activities with established process cadence. Anticipates and updates reporting requirements as needed.
-Establishes and maintains relationships with key community-based organizations. May include participation in community based or business meetings.
-Responsible for developing and maintaining a business relationship with IPA Navigator resources within given region, regular cadence of face to face interaction required.
-Responsible for developing annual regional Outreach Strategy Sales Plan, working in conjunction with internal key stakeholders with segment knowledge, staff and organic interaction with the community at large.
-Responsible for reporting Outreach Results in Quarterly Business Review with key management.
-Ability to travel to regional/staff and/or outreach efforts as assigned. In addition, attend quarterly on-site staff meeting and Adhoc organizational / department meetings..
Job Qualifications
Required Education
High School Diploma
Required Experience
-High School Diploma plus 5 years' experience in Managed Care. Associate degree plus 6 years' experience preferred; or Bachelor's Degree plus 4 years' experience. Team-lead experience a plus.
-Relevant business experience working in a managed care or other healthcare-related field with significant interface with the community/members.
-Strong project management skills and ability to work in a team environment.
-Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy.
-Excellent written and verbal communication skills.
-Ability to present information to a variety of audiences with effective follow-through.
-Strong organizational and leadership skills. Knowledge of MS office, (Word, Excel, Access), Lotus Notes (calendar, email), Salesforce client relationship management (CRM) tool and other technical applications as appropriate.
-Ability to establish priorities and make decisions that support corporate strategies and operations with minimum supervision.
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: $49,930 - $97,363 yearly*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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