Molina Healthcare

Compensation

Full Description

Job Description • *California resident preferred. JOB DESCRIPTION Job Summary Leads and manages 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 other 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. Essential Job Duties • Responsible for leading and managing performance of one or more of the following activities: care review, care management, transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment. • Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model. • Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff. • Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care. • Oversees interdisciplinary care team (ICT) meetings. • Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities. • 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. • 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, while identifying opportunities for improvement. • Local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • At least 1 year of health care management leadership experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Experience working within applicable state, federal, and third party regulations. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsive in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • 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. • Clinical experience. Work Schedule: California Pacific Time Zone, daytime business hours. Candidates who do not live in CA must work Pacific hours permanently. 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