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. Responsible for oversight and performance of the clinical and non-clinical functions of the maternity management program. Works cross functionally to establish and support maternal child health program offerings for Molina. 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

　　Directs and oversees one of the following key Healthcare Services functions: case management/disease management/care transitions.

　　Collaborates with internal stakeholders to support the development and enhancement of Molina's maternal child clinical model.

　　Monitors program KPI's creating and monitoring action plans to improve program performance.

　　Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care review and management.

　　Develops, performs, and promotes interdepartmental integration and collaboration to enhance clinical services.

　　Collaborates with and keeps the AVP or VP of Healthcare Services informed of operational issues, staffing, resources, system, and program needs and presents solution action plan for issues.

　　Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote standardized Molina enterprise-wide approach to Care Management programs.

　　Ensures monthly auditing is occurring with appropriate follow-up.

　　Engaged in clinical training activities.

　　Develops and mentors HCS managers and supervisors.

　　JOB QUALIFICATIONS

　　Required Education

　　Bachelor's Degree in Healthcare-related field (equivalent combination of education, experience and/or Nursing license will be considered in lieu of Bachelor's Degree).

　　Required Experience

　　10 years maternal child health care experience

　　5+ years managed care experience

　　7+ years managed healthcare experience with line management responsibility including clinical operations.

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

　　Required License, Certification, Association

　　If licensed, license must be active, unrestricted and in good standing.

　　Preferred Education

　　Bachelor's Degree in Nursing or a master’s degree in Business, Social Work or other healthcare related field.

　　Preferred Experience

　　10+ years managed care experience

　　Operational and process improvement experience

　　Experience with clinical model design

　　Experience managing large projects consisting of cross functional workgroups

　　Preferred License, Certification, Association

　　Active, unrestricted State Registered Nursing (RN) license in good standing.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: $79,607.91 - $172,483.8 / ANNUAL

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