Sr Specialist, Government Contracts (Must Live in IL Remote)
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What you'll do
- Supports government contracts activities including coordinating, conducting and/or responding to research requests pertaining to government health care programs, preparing and submitting regulatory reports for filings, reviewing plan submissions for quality, accuracy and timeliness, and ensuring plan meets contractual and regulatory requirements.
- Reviews provider agreements, evidence of coverage (EOC), member handbook, provider directory, marketing materials, and other contract reporting deliverables for compliance with contractual and regulatory requirements prior to submission.
- Assesses information received from government contracting agencies and regulators and disseminates to impacted plan staff.
- Participates in meetings related to Molina government run programs with state agencies and Molina corporate departments and disseminates relevant information to staff and leadership.
- Oversees/maintains the department's documentation and archive system - ensuring submitted reports are archived for historical and audit purposes; ensures system is updated and complete.
- Conducts structured evidence reviews/audits of new regulatory mandates contract amendments and other operational implementations, and verifies that Molina business units have implemented required changes.
What they're looking for
- At least 3 years of experience in Medicaid, Medicare, and/or Marketplace health insurance/government programs, and at least 1 year of experience in government contracts, or equivalent combination of relevant education and experience.
- Knowledge of Medicaid, Medicare, Marketplace and/or other government-sponsored programs and program compliance.
- Organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
- Detail oriented and analytical reasoning abilities.
- Proficient in analyzing and compiling data, creating reports, and presenting information.
- Ability to work cross-functionally in a highly matrixed environment.
- Effective verbal, written, and interpersonal communication skills, including ability to communicate and present to internal and external stakeholders.
- Microsoft Office suite and applicable software programs proficiency.
Nice to have
- Compliance-related experience.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Molina Healthcare of Illinois is hiring a Sr. Specialist, Government Contracts in Illinois. This position is remote; however, candidates must reside in Illinois.
This role supports the development, review, submission, implementation, and ongoing maintenance of government contract documents and regulatory requirements across Medicaid and DSNP. The position helps ensure compliance with state and federal requirements, which directly impacts member access to services, provider network operations, and Molina's ability to successfully administer government programs.
The specialist role is responsible for coordinating regulatory deliverables, monitoring compliance requirements, supporting contract implementation and state contract amendments, and partnering across departments to ensure Molina meets contractual obligations.
Provides senior level support for government contracts activities. Responsible for the development and administration of contracts with state and/or federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations in designated Molina markets.
Highly Qualified Candidates Will Have the Following Experience:
- MCO experience and ability to interpret contract language
- Relevant government healthcare contracting experience
- Project management
- Strong analytical skills, attention to detail, excellent written communication, organization, and experience working in a highly regulated environment
Essential Job Duties
• Supports government contracts activities including coordinating, conducting and/or responding to research requests pertaining to government health care programs, preparing and submitting regulatory reports for filings, reviewing plan submissions for quality, accuracy and timeliness, and ensuring plan meets contractual and regulatory requirements.
• Reviews provider agreements, evidence of coverage (EOC), member handbook, provider directory, marketing materials, and other contract reporting deliverables for compliance with contractual and regulatory requirements prior to submission.
• Assesses information received from government contracting agencies and regulators and disseminates to impacted plan staff.
• Participates in meetings related to Molina government run programs with state agencies and Molina corporate departments and disseminates relevant information to staff and leadership.
• Oversees/maintains the department’s documentation and archive system - ensuring submitted reports are archived for historical and audit purposes; ensures system is updated and complete.
• Conducts structured evidence reviews/audits of new regulatory mandates contract amendments and other operational implementations, and verifies that Molina business units have implemented required changes.
Required Qualifications
• At least 3 years of experience in Medicaid, Medicare, and/or Marketplace health insurance/government programs, and at least 1 year of experience in government contracts, or equivalent combination of relevant education and experience.
• Knowledge of Medicaid, Medicare, Marketplace and/or other government-sponsored programs and program compliance.
• Organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Detail oriented and analytical reasoning abilities.
• Proficient in analyzing and compiling data, creating reports, and presenting information.
• Ability to work cross-functionally in a highly matrixed environment.
• Effective verbal, written, and interpersonal communication skills, including ability to communicate and present to internal and external stakeholders.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
• Compliance-related experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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