JOB DESCRIPTION

　　Job Summary

　　Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

　　KNOWLEDGE/SKILLS/ABILITIES

　　The Manager, Healthcare Services provides operational management and oversight of integrated Healthcare Services (HCS) teams responsible for providing Molina Healthcare members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes.

　　Responsible for clinical teams (including operational teams, where integrated) performing one or more of the following activities: care review/utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), discharge planning and transition of care.

　　Department activity may involve creating and maintaining training documents, performing training for all members of the Utilization Management department, writing, reviewing, and updating Clinical Policy and Utilization Management Department specific policies, and oversight of the Utilization Management Committee

　　The Manager ensures that services utilized are in compliance with authorization and utilization management guidelines.

　　The Manager will also monitor performance of the Utilization Management department and individual members and takes appropriate action to ensure department goals are met and that staff are utilizing appropriate guidelines to make medical necessity decisions.

　　Typically, through one or more direct report supervisors, facilitates integrated, proactive HCS 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, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation and mentoring of new staff.

　　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 and 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.

　　JOB QUALIFICATIONS

　　Required Education

　　A minimum of an associate degree in nursing is required.Required Experience

　　5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management.

　　Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.

　　Experience working within applicable state, federal, and third-party regulations.

　　Required License, Certification, Association

　　An active, Registered Nurse (RN) or Licensed Practical Nurse (LPN) license to practice as a health professional in a state or territory of the United States is required for this role.

　　Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

　　Preferred Education

　　Master's Degree preferred.

　　Preferred Experience

　　3+ years supervisory/management experience in a managed healthcare environment.

　　Medicaid/Medicare Population experience with increasing responsibility.

　　3+ years of clinical nursing experience.

　　Preferred License, Certification, Association

　　Any of the following:

　　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 intranet job listing.

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

　　Pay Range: $65,791.66 - $142,548.59 / ANNUAL

　　*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.