JOB DESCRIPTION Job Summary
Work Location: California - Ability to work remote, but selected candidate must
reside in the state of California.
This position requires California RN Licensure. Candidates must have
significant IPA delegation experience.
Leads and directs a multidisciplinary team of healthcare services professionals
in some or all of the following functions: utilization management, care
management, behavioral health and other programs. Leads team responsible for
assessing, facilitating, planning and coordinating integrated delivery of care
across the continuum. Participates with senior leadership to establish strategic
plans and objectives. Contributes to overarching strategy to provide quality and
cost-effective member care.
Essential Job Duties
• Directs and oversees one or more of the following key health care services
functions: care management, utilization management, care transitions, long-term
supports and services (LTSS), behavioral health, nurse advice line, and/or other
special programs.
• Develops, implements and/or monitors standardized protocols for clinical and
non-clinical team activities to facilitate integrated proactive care
coordination/care review and management.
• Develops and promotes interdepartmental integration and collaboration to
enhance clinical services.
• Collaborates with and keeps healthcare services senior leadership informed of
operational issues, staffing, resources, system and program needs and presents
solutions/action plans for issues.
• Facilitates and participates in committees, task forces, work groups and
multidisciplinary teams as needed to promote a standardized enterprise-wide
approach to healthcare services programs.
• Ensures monthly auditing is occurring with appropriate follow-up.
• Engages in clinical training activities and outcomes.
• Develops and mentors direct reporting healthcare services leadership.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
•At least 8 years health care experience, and at least 5 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 3 years health care management/leadership required.
• 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.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Ability to work cross-collaboratively across a highly matrixed organization.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Registered Nurse (RN). 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.
• Clinical experience.
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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