Full-Time
Director Health Plan Operations
Molina Healthcare
10,001+ employees
Administers government-sponsored Medicaid, Medicare plans
Compensation Overview
$97.3k - $189.7k/yr
Florida, USA
Remote
Must reside in Florida.
 Business & Strategy (1) |
|---|
Get referred to Molina Healthcare
See people who can refer or advise you
- At least 8 years of health care operations, health care administration, and/or provider services experience, or equivalent combination of relevant education and experience.
- At least 3 years of management/leadership experience.
- Advanced experience with Medicare, Medicaid, and Marketplace plans.
- Experience with prompt pay laws.
- Advanced claims-related experience.
- Demonstrated adaptability and flexibility to change, and to new ideas and approaches.
- Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
- Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
- Project management experience.
- Excellent verbal and written communication skills.
- Microsoft Office suite proficiency (including Excel), and applicable software programs proficiency.
- Under the direction of senior leadership, organizes, plans, staffs, and coordinates health plan operations for market-specific designated lines of business (Medicaid, Marketplace).
- Collaborates with staff and senior leadership to develop and implement provider and member service strategies to improve access and satisfaction for designated health plan(s).
- In conjunction with senior leadership, liaises with corporate operations functions including: claims, configuration information management, provider data management, credentialing, enrollment, and support center operations.
- Oversees claims operations and configuration information management as applicable, and collaborates with corporate business owners and centers of excellence (COEs) to ensure the health plan processes for claims and encounters align with regulatory requirements for each applicable line of business.
- Collaborates with applicable functional COEs to ensure enrollment and support center operations comply with health plan requirements; collaborates with COEs and corporate business owners to mitigate risk related to enrollment processes and support center performance.
- Oversees the plan's provider network administration activities, specifically ensuring that corporate staff receive data to load correct provider, contract and benefit configuration to support accurate claims payment and accurate provider directories.
- Oversees provider credentialing activities as applicable, and collaborates with the functional COE to ensure compliance with regulatory requirements.
- Oversees the provider issue research and resolution function and the provider claim reconsideration process; coordinates activities and executes strategies to address opportunities to improve provider satisfaction and reduce operational risk in conjunction with provider services.
- Collaborates with the member appeals and grievances (A&G) COE to obtain related analytics, identify trends and execute strategies to improve member satisfaction.
- Supports effective member retention strategies to achieve desired retention goals; also serves as a key partner with community outreach to achieve profitable growth.
- Supports member stakeholder experience team initiatives including: member static website, member web portal and Customer Relationship Management (CRM); ensures compliance with regulatory requirements and successful communication and implementation with members, employees and other key stakeholders to limit operational impact.
- Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
Molina Healthcare provides government-sponsored health plans in the United States, primarily serving low-income individuals and families through Medicaid, Medicare, and Marketplace products. It partners with state and federal governments to administer these programs and earns revenue from member premiums and payments for program management. A key differentiator is its focus on cost management and preventive care, aided by an online provider portal that lets clinicians verify eligibility, submit claims, and access resources. Its goal is to expand access to affordable, quality health coverage while delivering sustainable administration of government-backed plans.
Company Size
10,001+
Company Stage
IPO
Headquarters
Long Beach, California
Founded
1980
Get referred to Molina Healthcare
See people who can refer or advise you
Simplify's Take
What believers are saying
- July 22, 2026 results beat estimates, with $1.51 adjusted EPS on $10.87 billion revenue.
- Molina raised 2026 adjusted EPS guidance to at least $5.25 after Medicaid strength.
- June 23, 2026 partnerships in New Mexico and Iowa extend local member acquisition.
What critics are saying
- Marketplace guidance flipped to a $0.75 loss, and 2027 cuts remove $1 billion premiums.
- The Florida Medicaid contract adds a $1.50 EPS hit in fourth quarter 2026.
- A federal securities class action filed in Central District of California attacks guidance credibility.
What makes Molina Healthcare unique
- Molina dominates government-sponsored coverage, especially Medicaid and Medicare, across 21 states.
- Its community-service centers in Buffalo and Albuquerque directly convert language access into enrollment.
- The integrated care model bundles eligibility, claims, primary care, and disease management.
Help us improve and share your feedback! Did you find this helpful?
Benefits
Health Insurance
401(k) Retirement Plan
Remote Work Options
Paid Vacation
Flexible Work Hours
Wellness Program
Mental Health Support
Conference Attendance Budget
Professional Development Budget
Phone/Internet Stipend
Home Office Stipend
Family Planning Benefits
Fertility Treatment Support
Stock Options
Company Equity
Hybrid Work Options
PTO/vacation mention not explicit beyond Paid Vacation
Paid Sick Leave
Paid Holidays
Adoption Assistance
Company News
Kentucky kindergarten vaccination rates among lowest in nation. Posted: Aug 5, 2026 / 03:16 PM CDT Updated: Aug 5, 2026 / 03:16 PM CDT * Kentucky ranked fifth lowest nationally for kindergarten vaccination rates during the previous school year. * Measles cases nationwide reached a 35-year high throughout the first seven months of 2026. * Community organizations offered free medical services and supplies to help families prepare for school. KENTUCKY (FOX 56) - As Kentucky students return to classrooms, health officials are raising concerns about the state's kindergarten vaccination rates, which rank among the lowest in the nation. According to the Centers for Disease Control and Prevention's SchoolVaxView survey, Kentucky ranked fifth lowest in the country for kindergarten vaccination rates during the last school year. About 86% of Kentucky kindergarteners were up to date on required vaccines, compared with the national average of 91%. Dr. Stanton said maintaining high vaccination rates is important not only for individual students but for the broader community. "There are a lot of things that were very bad a century ago that we have gotten rid of, or almost completely eradicated, because of vaccinations," Stanton said. "As a health care professional, we don't want to see a return to these times where there's such high risk on things we can prevent." Health experts say vaccinations help protect people who cannot receive vaccines or who may not develop a strong immune response after vaccination. "Herd immunity is incredibly important because some people simply can't get the vaccinations and others don't respond or don't build an appropriate immune response to that vaccination," Dr. Stanton said. "So we're protecting them." Latest KENTUCKY news: He says herd immunity is also important when it comes to measles, given how contagious the virus is. He says 96% vaccination rates are needed for herd immunity. "We're already seeing a 35-year high in measles cases across this country in 2026 through the end of July had already seen as many cases as all of 2025, and those numbers are going to continue to grow," Dr. Stanton said. To help families prepare for the school year, organizations are providing resources before classes begin. Passport by Molina Healthcare hosted a back-to-school event at its One Stop Help Center in Lexington, offering families free physicals, vaccinations and dental care through a partnership with Kare. The event also provided backpacks and new shoes donated by community organizations. "It is important because we want our kids to be in the best shape to start school," said Mendez. "So vaccines, dental and medical care are an important part of getting ready for school." Despite the benefits of vaccination, Dr. Stanton said misinformation continues to contribute to vaccine hesitancy among some parents. One common concern he hears is that natural immunity is stronger than immunity from vaccines. Dr. Stanton said vaccines protect while avoiding the risks associated with contracting preventable diseases. "The challenge we're facing right now is just this simple distrust," Stanton said. "It was already existing, but it was fueled significantly by the COVID pandemic." As families complete their back-to-school preparations, Stanton encourages parents to rely on medical professionals and evidence-based sources when making health decisions. "I would strongly encourage you to talk to a pediatrician or use legitimate evidence-based sources and have those conversations, because when you make these decisions, you're making the decision for a child or a newborn that can't make decisions on their own," said Dr. Stanton.
161,033 shares in Molina Healthcare, Inc $MOH purchased by Segall Bryant & Hamill LLC. August 2, 2026 Key points. * Segall Bryant & Hamill LLC acquired 161,033 Molina Healthcare shares worth approximately $21.5 million, giving it a 0.31% stake. Institutional investors and hedge funds collectively own 98.5% of MOH. * Analysts raised several price targets, including UBS to $202 and Bank of America to $250, but the overall consensus remains a "Hold" rating with a $202.44 price target. * Molina reported quarterly EPS of $1.51, beating estimates of $1.39, while revenue reached $10.87 billion. However, revenue declined 4.8% year over year, and insiders recently sold shares. * Five stocks to consider instead of Molina Healthcare. Segall Bryant & Hamill LLC purchased a new position in shares of Molina Healthcare, Inc (NYSE:MOH - Free Report) in the first quarter, according to the company in its most recent 13F filing with the Securities and Exchange Commission (SEC). The firm purchased 161,033 shares of the company's stock, valued at approximately $21,466,000. Segall Bryant & Hamill LLC owned 0.31% of Molina Healthcare as of its most recent SEC filing. A number of other institutional investors also recently added to or reduced their stakes in MOH. Torren Management LLC bought a new position in shares of Molina Healthcare during the 4th quarter worth approximately $26,000. MUFG Securities EMEA plc acquired a new stake in Molina Healthcare in the 2nd quarter valued at $48,000. Cromwell Holdings LLC grew its position in Molina Healthcare by 211.9% in the fourth quarter. Cromwell Holdings LLC now owns 184 shares of the company's stock valued at $32,000 after acquiring an additional 125 shares during the period. Quarry LP bought a new stake in Molina Healthcare in the fourth quarter valued at $32,000. Finally, Triumph Capital Management raised its stake in Molina Healthcare by 4,625.0% during the fourth quarter. Triumph Capital Management now owns 189 shares of the company's stock worth $33,000 after acquiring an additional 185 shares in the last quarter. 98.50% of the stock is owned by institutional investors and hedge funds. Analysts set new price targets. MOH has been the subject of a number of analyst reports. Robert W. Baird lifted their price objective on Molina Healthcare from $124.00 to $163.00 and gave the company a "neutral" rating in a report on Monday, May 11th. Bank of America raised shares of Molina Healthcare from an "underperform" rating to a "buy" rating and set a $250.00 target price on the stock in a report on Wednesday, April 29th. Wall Street Zen upgraded shares of Molina Healthcare from a "sell" rating to a "hold" rating in a research report on Saturday, May 2nd. Morgan Stanley lifted their price target on shares of Molina Healthcare from $146.00 to $167.00 and gave the company an "equal weight" rating in a report on Thursday, June 4th. Finally, UBS Group boosted their price target on shares of Molina Healthcare from $180.00 to $202.00 and gave the company a "neutral" rating in a research report on Friday, May 22nd. One equities research analyst has rated the stock with a Strong Buy rating, three have issued a Buy rating, eleven have issued a Hold rating and two have assigned a Sell rating to the company's stock. According to MarketBeat, the stock presently has a consensus rating of "Hold" and a consensus price target of $202.44. Discover more Options Profit Calculator Dividend Screener Tool ETF Screener Tool Insider activity. In other Molina Healthcare news, CAO Maurice Hebert sold 600 shares of the stock in a transaction dated Thursday, May 14th. The shares were sold at an average price of $191.55, for a total transaction of $114,930.00. Following the sale, the chief accounting officer owned 12,815 shares of the company's stock, valued at $2,454,713.25. This represents a 4.47% decrease in their position. The sale was disclosed in a legal filing with the Securities & Exchange Commission, which can be accessed through this hyperlink. Also, insider Jeff D. Barlow sold 17,811 shares of the firm's stock in a transaction dated Monday, May 11th. The shares were sold at an average price of $186.12, for a total transaction of $3,314,983.32. Following the completion of the sale, the insider owned 67,175 shares of the company's stock, valued at $12,502,611. The trade was a 20.96% decrease in their position. The SEC filing for this sale provides additional information. 1.44% of the stock is owned by corporate insiders. Molina Healthcare trading up 0.7%. Shares of MOH opened at $196.10 on Friday. The stock has a fifty day moving average price of $207.67 and a two-hundred day moving average price of $177.58. The company has a debt-to-equity ratio of 0.95, a quick ratio of 1.68 and a current ratio of 1.68. Molina Healthcare, Inc has a 52-week low of $121.06 and a 52-week high of $244.89. The company has a market cap of $10.24 billion, a price-to-earnings ratio of -1,089.40, a PEG ratio of 28.02 and a beta of 0.74. Molina Healthcare (NYSE:MOH - Get Free Report) last announced its earnings results on Wednesday, July 22nd. The company reported $1.51 EPS for the quarter, topping the consensus estimate of $1.39 by $0.12. Molina Healthcare had a positive return on equity of 3.73% and a negative net margin of 0.02%.The company had revenue of $10.87 billion for the quarter, compared to analysts' expectations of $10.83 billion. During the same quarter in the prior year, the business earned $5.48 earnings per share. The business's revenue for the quarter was down 4.8% on a year-over-year basis. Analysts predict that Molina Healthcare, Inc will post 5.29 EPS for the current fiscal year. Molina Healthcare company profile. Molina Healthcare, Inc is a managed care company specializing in government-sponsored health insurance programs. The company offers Medicaid managed care plans, Medicare Advantage and prescription drug plans, and individual Marketplace plans under the Affordable Care Act. Through an integrated care model, Molina emphasizes preventive and primary care services, care coordination, and disease management to improve health outcomes for its members. The company traces its roots to the early 1980s, when Dr. Want to see what other hedge funds are holding MOH? Visit HoldingsChannel.com to get the latest 13F filings and insider trades for Molina Healthcare, Inc (NYSE:MOH - Free Report). This instant news alert was generated by narrative science technology and financial data from MarketBeat in order to provide readers with the fastest reporting and unbiased coverage. Please send any questions or comments about this story to [email protected]. Before you consider Molina Healthcare, you'll want to hear this. MarketBeat keeps track of Wall Street's top-rated and best performing research analysts and the stocks they recommend to their clients on a daily basis. MarketBeat has identified the five stocks that top analysts are quietly whispering to their clients to buy now before the broader market catches on... and Molina Healthcare wasn't on the list. While Molina Healthcare currently has a Hold rating among analysts, top-rated analysts believe these five stocks are better buys. Tesla, Nvidia, and Google helped shape the last era of market growth, but the next wave could come from a new group of companies. Inside this report, you'll find 7 stocks that could play a major role in the next tech-driven market boom.
Patients wait up to 6 months for mammograms in rural Pierce Co. New unit to help. July 25, 2026 5:00 AM Gift Article Peninsula Community Health Services announced it will deploy its first mobile mammography unit this fall, expanding access to breast cancer screenings across the Kitsap Peninsula. PCHS, a federally qualified health center that serves over 52,000 patients across Kitsap, Mason, and rural Pierce County, will now have a fully equipped medical vehicle that brings preventative breast cancer screenings directly to communities. "This approach reaches women who can't travel to places like Silverdale or Poulsbo and the goal is to help reduce long wait times - often six months or more," Lynette Bird, chief operating officer of PCHS wrote in an email to The News Tribune. "By meeting patients where they are, we can get more women screened, sooner." In a July press release, Molina Healthcare of Washington announced it presented PCHS with a $75,000 grant to support the deployment of the unit. According to the press release, early detection is vital when improving outcomes for breast cancer. The National Breast Cancer Foundation said when breast cancer is caught in its earliest, localized stages, the five-year relative survival rate is over 99%. The press release also said that as of 2022, the American Society found about a third of Washington women did not receive regular screenings while in Pierce County only 66.9% of women received a mammogram in the past two years, per the National Institute of Health's Cancer Institute. Mammograms are typically recommended for women ages 40 and older and are done every two years. Audrey Silliman, director of value based care for Molina Healthcare of Washington, said the grant money is to help PCHS get the mobile unit up and running. Silliman said the funds will be used for recruiting and funding staff, such as mammography technicians, medical assistants, and drivers, and help PCHS obtain the necessary accreditation, licenses, and insurance to operate the unit. "Really the impetus for this work was a lack of access," Silliman told The News Tribune in a phone call. Silliman explained that common barriers, especially for those in rural areas, include transportation, insurance coverage, and scheduling challenges as well as lack of education and awareness on where to receive these screenings. Bird added that women often prioritize the needs of their families over their own wellbeing. "When you combine these factors, it becomes much easier to understand why screenings are delayed or missed," said Bird. The mobile mammography unit will be located at PCHS clinics and community locations in Bremerton, Key Peninsula, and Port Orchard. The News Tribune asked where the exact locations will be for the mobile unit but PCHS said it does not have further details at this time. Bird said services will be available to all PCHS-established patients and that the health center already has a list of patients who are due for a mammogram and will be proactively contacted by its customer service team to get them scheduled for a screening. She also said that patients can call PCHS's call center directly and other patients that are assigned through Managed Care, such as Molina Healthcare Washington, can be scheduled with no referral required. Bird explained that while most insurance plans cover mammography with no out-of-pocket costs under the Affordable Care Act, PCHS still offers a sliding fee scale to support patients that are uninsured and underinsured. Additionally, PCHS partners with the state's DOH Breast, Cervical, and Colon Health Program that covers mammograms and cervical cancer screening for those who are eligible. "By bringing services directly into communities and reducing logistical and financial barriers, we can reach patients who might otherwise fall through the cracks and provide earlier access to life-saving screenings," said Bird. The News Tribune Elizah Lourdes Rendorio is one of The News Tribune's news interns this summer. She recently graduated from the University of Washington, where she studied journalism and public interest communications. She previously worked at The Daily, Converge Media, and The Columbia Basin Herald, primarily covering local and state politics.
Molina Healthcare reported second-quarter adjusted earnings of $1.51 per share on $10.2 billion in premium revenue, beating expectations. The company raised its full-year 2026 adjusted EPS guidance by $0.25 to at least $5.25 per share, driven by stronger Medicaid performance and better-than-expected Medicare duals results. Medicaid remained stable, with management indicating 2026 may be a trough year for margins. The medical care ratio was 92.7% in the quarter, in line with expectations. The Marketplace segment underperformed, with higher medical costs forcing Molina to cut its full-year Marketplace outlook to a $0.75 per share loss from a prior expected gain. Management warned that 2027 will see a roughly $1 billion reduction in Marketplace premium as the company reduces exposure.
Molina Healthcare raised its annual profit forecast on Wednesday after second-quarter results beat Wall Street estimates. The health insurer now expects annual adjusted earnings of at least $5.25 per share, up from $5.00 previously. The company's shares fell over 9% in extended trading despite the raised forecast. Investors focused on the modest increase and ongoing pressures in some businesses, particularly its Marketplace division, which saw higher-than-expected medical costs. Chief executive Joseph Zubretsky said the imbalance between Medicaid rates and medical cost trends appears to have stabilised. For the quarter, Molina earned an adjusted profit of $1.51 per share, beating analysts' estimate of $1.39. Revenue fell 4.9% to $10.87 billion but exceeded the $10.79 billion estimate.