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This position will offer remote work flexibility; however, the selected candidate must reside in the state of Georgia.
Overview Leads and manages multidisciplinary team of healthcare services professionals in care management, utilization management, behavioral health, care transitions, LTSS, and/or other programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to strategy for quality and cost-effective member care.
Responsibilities Lead and manage performance of one or more activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, health management, behavioral health, LTSS, and/or member assessment.
Facilitate integrated, proactive healthcare services management while ensuring compliance with state and federal regulatory/accrediting standards and the Molina clinical model.
Manage and evaluate team member performance, provide coaching and staff development, ensure ongoing training, and oversee selection, orientation and mentoring of new staff.
Perform and promote interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
Oversee interdisciplinary care team (ICT) meetings.
Supervise and coordinate daily integrated healthcare service activities.
Ensure adequate staffing and service levels and maintain customer satisfaction by monitoring staff productivity and other performance indicators.
Collate and report on care access and monitoring statistics, including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member populations, and triage activities.
Ensure completion of staff quality audit reviews; evaluate services and outcomes, and recommend enhancements for programs and staff development to ensure cost-effectiveness and regulatory compliance.
Maintain professional relationships with provider community, internal/external customers, and state agencies as appropriate; identify opportunities for improvement.
Local travel may be required (based upon state/contractual requirements).
Required Qualifications At least 7 years of experience in health care, and at least 3 years of managed care experience in one or more of: utilization management, care management, care transitions, behavioral health, LTSS, or an 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/certification required only if required by state contract, regulation, or licensing mandates. If licensed, license must be active/unrestricted in state of practice.
Experience working within applicable state, federal, and third-party regulations.
Demonstrated knowledge of community resources.
Proactive and detail-oriented; able to work independently with minimal supervision and self-motivation.
Responsive in all forms of communication and able to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management, prioritization, and ability to manage multiple projects and adapt to change.
Excellent problem-solving and critical-thinking skills; excellent verbal and written communication skills.
Microsoft Office suite/applicable software proficiency.
Preferred Qualifications RN license active and unrestricted in state of practice.
CCM, CPHM, CPHQ, or other health care/management certification.
Medicaid/Medicare population experience.
Clinical experience.
Additional Information 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.
Pay and Location Details Pay Range: $73,102 - $142,549 / ANNUAL
Seniority level: Mid-Senior level
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
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