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Supv, BH Care Mgt./Review

Expired Job

Molina Healthcare Syracuse , NY 13201

Posted 3 months ago

State of New York Pan Specific:

We are excited to Celebrate Molina Healthcare in the New York Market for the several years. Word is spreading and our membership is expanding and becoming more robust. We are excited to expand our Services. With 13 States Nationally, New York is quickly becoming a strong player in the New York market. We are very excited that the State of New York Department of Medicaid recently allowed for services to be provided to Children as part of Medicaid coverage carve in. This role would Supervise a team that would offer services to a large variety of ages, however would include the new services to children. The role would cover Care Management as well as Utilization Review.

This role in New York is part of a larger Medicaid Care Management effort. Come be a part of transforming the lives of fellow New Yorkers.

Job Summary

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.

Job DescriptionKnowledge/Skills/Abilities

  • Oversees an integrated Care Access and Monitoring team responsible for care manager and prior authorizations and/or other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time.

  • Functions as a hands-on supervisor, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive care management and utilization management, ensuring compliance with regulatory and accrediting standards.

  • Manages and evaluates team members in the performance of various care management and utilization management activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new staff.

  • Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care.

  • Ensures adequate staffing and service levels and maintains member satisfaction by implementing and monitoring staff productivity and other performance indicators.

  • Monitoring and reports on statistics including plan utilization, staff productivity, cost effective care management and utilization of services, as well management of targeted member population, and triage activities.

  • Completes staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.

Corporate Job Description/does not apply to the New York Plan:

Job Summary

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.

Knowledge/Skills/Abilities

  • Oversees an integrated Care Access and Monitoring team responsible for prior authorizations and/or other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time.

  • Functions as a hands-on supervisor, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.

  • Manages and evaluates team members in the performance of various utilization management activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new staff.

  • Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including Behavioral Health and Long Term Care for Molina members.

  • Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.

  • Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.

  • Completes staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.

  • Provides feedback on annual prior authorization policy changes.

  • Ensures prior authorization materials are updated annually and communicated appropriately to Molina providers and staff.

  • Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement.

Job QualificationsNew York Plan Specific:

Required Education

Masters Social Work, Mental Health Counseling. LMSW or LMHC

Required Experience

  • 3 years hospital or out patient behavioral health services.
  • 2 years care management and utilization management experience.

Experience working with members of all ages.

  • Experience demonstrating leadership skills.

Required License, Certification, Association

Unrestricted New State License in Social Worker/licensed mental healthcare counseling.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Experience
5 years clinical practice with managed care, care management and utilization management working with individuals of all ages utilization management experience.
3 years supervisory experience in a managed healthcare environment.

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.


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VIEW JOBS 11/29/2018 12:00:00 AM 2019-02-27T00:00 Job Description Job Summary 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. Knowledge/Skills/Abilities * Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. * Analyzes clinical service requests from members or providers against evidence based clinical guidelines. * Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. * Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. * Processes requests within required timelines. * Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. * Requests additional information from members or providers in consistent and efficient manner. * Makes appropriate referrals to other clinical programs. * Collaborates with multidisciplinary teams to promote Molina Care Model. * Adheres to UM policies and procedures. * Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.Job Qualifications Required Education Graduate from an Accredited School of Nursing. Required Experience 3 years hospital acute care/medical experience. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) license in good standing. Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. Preferred Education Bachelor's Degree in Nursing Preferred Experience Recent hospital experience in ICU, Medical, or ER unit. Preferred License, Certification, Association Utilization Management Certification (CPHM). 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. Molina Healthcare Syracuse NY

Supv, BH Care Mgt./Review

Expired Job

Molina Healthcare