Job Description

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, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), 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: utilization management, 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), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, 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

• Medicaid/Medicare Population experience with increasing responsibility.
• 3+ years of clinical nursing experience.
• CalAIM experience, specifically Community Supports
• Experience working with Community Based Organizations (CBO) or working for a CBO/provider
• Data/reporting experience, Microsoft Office proficiency (navigate Excel files, reports/dashboards, work directly with reporting teams to provide business requirements)
• SDOH experience
• Certified Case Manager (CCM), Certified Professional in Healthcare 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 Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V