Geared toward healthcare professionals with leadership potential comfortable with integrated care delivery and regulatory compliance. This role is based in the United States and involves managing a multidisciplinary team.
Derived from job-description analysis by Serendipath's career intelligence engine.
Original posting from Molina Healthcare
JOB DESCRIPTION
Job Summary
Leads and supervises a multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
*PST Hours*
Essential Job Duties
- Oversees team performance for one or more of the following healthcare services functions: care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, behavioral health, long-term services and supports (LTSS), and/or special programs.
- Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
- Functions as a “hands-on” leader - assisting with assessing and evaluation of systems, day-to-day operations and efficiency of services/care delivery.
- Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
- Assists in implementing care management, utilization management, behavioral health, care transitions, LTSS and other program activities in accordance with regulatory, contract standards and accreditation compliance.
- Ensures delivery of member care and services are aligned with Molina's established standards of customer service excellence.
- Ensures high-risk, complex members are adequately supported.
- Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services.
- Collaborates with and keeps senior level healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
- Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
- Oversees interdisciplinary care team (ICT) meetings.
- Analyzes 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.
- Ensures completion of staff quality audit reviews evaluates services provided, 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.
- Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate.
- Identifies opportunities for care delivery/quality/operational/etc. process improvements.
- Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.
- Local travel may be required (based upon state/contractual requirements).
Required Qualifications
- At least 5 years of health care experience, including at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and experience.
- Registered Nurse (RN), Licensed Vocational Nurse (LVN), and Licensed Practical Nurse (LPN). If licensed, license must be active and unrestricted in state of practice.
- Strong customer service skills/member-centric focus.
- Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations.
- Ability to prioritize and manage multiple deadlines.
- Strong organizational and problem-solving skills.
- Ability to collaborate cross-functionally within a highly matrixed organization.
- Strong written and verbal communication skills.
- Microsoft Office suite and applicable software program(s) proficiency.
Preferred Qualifications
- Management/leadership experience.
- Clinical experience.
- Registered Nurse (RN) or master's level behavioral health (BH) licensure. License must be active and unrestricted in state of practice.
- Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
- Medicaid/Medicare population 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 a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Source: Molina Healthcare careers