Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Provides strategic direction and oversight for one or more of the following key Healthcare Services functions: case management/disease management/care transitions; utilization management; long-term supports and services; and/or nurse advice line.
Determines clinical, quality, and financial measures for success.
Designs standardized protocols, develops policy, and ensures timely implementation with corporate and health plan input.
Ensures adequate training occurs from knowledgeable staff and coordinates with other departments as needed. Focuses on continual refinement of operational processes.
Develops, performs and promotes interdepartmental integration and collaboration to enhance clinical services.
Manages and evaluates team members in the performance of various clinical management activities.
Coordinates with the Vice President of Healthcare Services to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators.
Ensures monthly auditing is occurring with appropriate follow-up.
Engaged in clinical training activities and outcomes.
Develops and mentors HCS managers and supervisors.Job Qualifications
Graduate Degree (equivalent combination of education, experience, and/or Nursing license will be considered in lieu of Graduate Degree).
7 years managed care experience with line management responsibility including clinical operations.
Worked within applicable state, federal, and third party regulations.
Operational and process improvement experience
Required License, Certification, Association
If licensed, license must be active, unrestricted and in good standing.
Master's Degree in Business, Healthcare, Social Work or related field.
10 years managed care experience
Preferred License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification
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.