Mgr, Healthcare Services
Company: Molina Healthcare
Location: Frisco
Posted on: May 7, 2024
Job Description:
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.), case
management, transition of care, health management and/or member
assessment.
- 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.
- Performs and promotes interdepartmental/ multidisciplinary
integration and collaboration to enhance the continuity of care
including Behavioral Health and Long-Term Services & Supports for
Molina members. Oversees Interdisciplinary Care Team
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 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
- Registered Nurse or equivalent combination of Licensed
Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with
experience in lieu of RN license.
- OR Bachelor's or master's degree in Nursing, Gerontology,
Public Health, Social Work, or related field.
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
- If licensed, license must be active, unrestricted and in good
standing.
- 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.
#PJHS
#LI-AC1
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.
Keywords: Molina Healthcare, Euless , Mgr, Healthcare Services, Other , Frisco, Texas
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