Health Plan Representatives

Market CFO, CA Health Plan

• Remote

at Molina Healthcare in Caldwell, Idaho, United States

Job Description

JOB DESCRIPTION Job Summary Looking for an individual ready for a fast-paced environment. This individual will provide executive level strategy and leadership for market finance activities

• specifically provision of financial analysis to support business decisions including profitability initiatives for medical management metrics, member growth/retention ventures, targeted business extensions/expansions, rate advocacy efforts and other activities involving the finance function.

Provides subject matter expertise and collaboration on enterprise projects and priorities including standardization of reporting, systems application, staffing models, and other enterprise workstreams. Essential Job Duties

• Supports executive strategy development, vision and direction for market finance activities. Demonstrates accountability for market finance performance and financial results, and keeps executive leadership apprised.
• Creates a supportive and working environment for the finance team. Encouraging growth and creating opportunities for individual team members
• Coordinates efforts across market lines of businesses to ensure consistent processes for managing premium revenue including managed long-term services and supports (MLTSS) revenue management and appropriate risk adjustment. Reviews and analyzes premium rates within region for appropriateness. Develops analysis and arguments to support rate negotiations with states within designated market.
• Collaborates with policy and planning and government contracts leadership to ensure a consistent message to policy makers on rate developments as applicable. Reviews and analyzes financial terms of provider agreements and rate developments to provide recommended changes.
• Provides market support for provider report card/performance monitoring activities with regard to quality, pay for performance, clinical performance measurements, and quality improvement activities.
• Develops and standardizes approach to manage medical expenses. Collaborates with medical affairs, operations and health care services leadership to improve medical management efficiency and identify/implement profit improvement initiatives across market.
• Standardizes productivity measures for routine processing and administrative activities. Collaborates with senior leadership across all functions to establish standard metrics included in staffing models and identify opportunities for improvement. Reviews and analyzes regional administrative costs.
• Monitors actual to budget/forecast performance. Identifies and implements appropriate responses to variances.
• Works with shared services partners to support reporting, financial performance, common metrics and formatting and increase quality in all health care data analytical activities. Coordinates activities with enterprise to avoid duplication of work.
• Represents finance by participating on committees and multidisciplinary teams as needed.
• Standardizes encounters reconciliation activities across the market to ensure all encounters are successfully submitted and errors are resolved. Ensures the encounters process fully supports rate development, collection of case rate payments and maximizes risk scores while complying with state specific guidelines.
• Provides financial and business leadership for designated market.

Required Qualifications

• At least 12 years of progressive finance experience, and/or analytical experience, and 5 years managed care/Medicaid experience, and 3 years programming, relational database and financial analysis experience, or equivalent combination of relevant education and experience.
• At least 7 years management/leadership experience.
• Bachelor's degree in finance, accounting or related field.
• Advanced training or experience in health care analytics.
• Ability to build and maintain relationships, motivate and influence others.
• Decision-making and problem-solving skills.
• Ability to effectively collaborate with stakeholders across the organization and present at an executive level.
• Strong critical-thinking and attention to detail.
• Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
• May be required to reside in specific market/health plan state.

Preferred Qualifications

• Certified Public Accountant (CPA).

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. #PJCorp #LI-AC1 Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $190,000

• $280,000 / ANNUAL
• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Posting: JC288723364 Posted On: Mar 04, 2026 Updated On: Mar 05, 2026 Apply tot his job Apply To this Job