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VP, Compliance - Marketplace

Molina Healthcare

$161,914 - $315,732

Posted Jul 09

Full TimeUnited States

Job Summary

Ensures regulatory and contractual compliance with Marketplace state and federal requirements for Molina and/or state Health Plans. Works in collaboration with business units and senior leadership to effectively prevent and/or detect violations of applicable Marketplace laws and regulations, which will protect the Business from liability of non-compliance, as well as fraudulent or abusive practices.

Knowledge/Skills/Abilities

Oversees the Marketplace Government Contracts team which is responsible for implementation and guidance of statutory, regulatory, and contractual requirements, and maintaining a strong relationship with state and/or federal regulators, including, but not limited to, the following:

Responsible for the development, implementation, monitoring/oversight, and ongoing effectiveness of the Molina Marketplace compliance program, the Marketplace Government Contracts program in a highly matrixed environment
Strong leadership skills to partner with, motivate and influence cross-functional teams, driving compliance and collaboration within business units for the Marketplace segment
Lead the Marketplace compliance team to ensure Molina operates in compliance with relevant industry regulations and state and federal laws to avoid instances of non-compliance, fines, enforcement actions and reputational damage.
Acts as leader-partner with Molina Chief Compliance Officer and other Compliance leadership, as well as executive and senior business leaders to ensure the an effective/efficient Marketplace Compliance program and culture of compliance
Clearly articulate marketplace regulatory requirements, updates, and convey complex compliance issues to other Molina/Marketplace executives, team members and external partners.
Provides Marketplace compliance leadership, oversight, and subject matter expertise to Marketplace Product, Segment, and operational teams while adapting to changing Marketplace compliance regulations and business needs/processes.
Develop Marketplace Compliance and Government Contracts team strategy and goals in alignment with departmental and Corporate goals.
Ability to build and maintain strong relationships with internal functional areas (Legal, IT, Claims, Marketplace Segment and Product, Contact Center, UM, etc.) and external partners including delegated vendors and state and federal regulators.
Stays abreast of industry and compliance Marketplace trends; recommends and implements changes to internal company policies, programs, and processes as needed.
Works in collaboration with MHI Compliance Central Support Services on audits, corrective actions plans, FWA and other reporting requirements, metrics and achievements.
Leads Compliance governance and leadership reporting to assure that Marketplace compliance requirements are met and compliance risks are managed through business performance and oversight is effectively exercised and communicated.
Oversee Marketplace Government Contracts team responsible for day to day contract management and annual QHP certification activities.
Serve as primary point of contact for CMS Account Manager and their delegates for the Marketplace segment
Develop and maintain a standardized process to track, disseminate, monitor and implement state and federal legislation across states with a Marketplace product.
Ensure Marketplace QHP annual filings and required regulatory reports are completed accurately and timely as well as advise on regulatory matters.
Professionally develop and coach direct reports to support their goals and ensure success.