Manager, Healthcare Services (RN) Registered Nurse ( California )
Job Description
ā¢ *California resident preferred.
JOB DESCRIPTION
Job Summary
Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
ā¢ Responsible for leading and managing performance of one or more of the following activities: care review, care management, transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment.
ā¢ Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
ā¢ Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff.
ā¢ Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
ā¢ Oversees interdisciplinary care team (ICT) meetings.
ā¢ Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
ā¢ Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
ā¢ 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.
ā¢ Ensures completion of staff quality audit reviews; evaluates services provided, 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.
ā¢ Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
ā¢ Local travel may be required (based upon state/contractual requirements).
Required Qualifications
ā¢ At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
ā¢ At least 1 year of health care management leadership experience.
ā¢ Registered Nurse (RN). License must be active and unrestricted in state of practice.
ā¢ Experience working within applicable state, federal, and third party regulations.
ā¢ Demonstrated knowledge of community resources.
ā¢ Proactive and detail-oriented.
ā¢ Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
ā¢ Ability to work independently, with minimal supervision and demonstrate self-motivation.
ā¢ Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
ā¢ Ability to develop and maintain professional relationships.
ā¢ Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
ā¢ Excellent problem-solving and critical-thinking skills.
ā¢ Excellent verbal and written communication skills.
ā¢ Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
ā¢ 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.
ā¢ Medicaid/Medicare population experience.
ā¢ Clinical experience.
Work Schedule: California Pacific Time Zone, daytime business hours. Candidates who do not live in CA must work Pacific hours permanently.
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
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ā¢ *California resident preferred.
JOB DESCRIPTION
Job Summary
Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
ā¢ Responsible for leading and managing performance of one or more of the following activities: care review, care management, transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment.
ā¢ Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
ā¢ Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff.
ā¢ Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
ā¢ Oversees interdisciplinary care team (ICT) meetings.
ā¢ Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
ā¢ Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
ā¢ 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.
ā¢ Ensures completion of staff quality audit reviews; evaluates services provided, 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.
ā¢ Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
ā¢ Local travel may be required (based upon state/contractual requirements).
Required Qualifications
ā¢ At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
ā¢ At least 1 year of health care management leadership experience.
ā¢ Registered Nurse (RN). License must be active and unrestricted in state of practice.
ā¢ Experience working within applicable state, federal, and third party regulations.
ā¢ Demonstrated knowledge of community resources.
ā¢ Proactive and detail-oriented.
ā¢ Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
ā¢ Ability to work independently, with minimal supervision and demonstrate self-motivation.
ā¢ Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
ā¢ Ability to develop and maintain professional relationships.
ā¢ Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
ā¢ Excellent problem-solving and critical-thinking skills.
ā¢ Excellent verbal and written communication skills.
ā¢ Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
ā¢ 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.
ā¢ Medicaid/Medicare population experience.
ā¢ Clinical experience.
Work Schedule: California Pacific Time Zone, daytime business hours. Candidates who do not live in CA must work Pacific hours permanently.
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
Apply tot his job
Apply To this Job