Job Summary Bring your UM and case management leadership experience to our Florida Health Plan. If you have proven decision-making & problem solving skills and the ability to work in a collaborative and changing environment, even better! The opportunity involves the need to roll up one's sleeves to work with 2 other Directors and a team of managers, supervisors and SMEs to assist in the restructuring of the department. If this describes you and your experience, please read further and apply today.
What you will do:
• Direct and oversee utilization management & case management/disease management/care transitions teams.
• Develop, implement and/or monitor standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care review and management.
• Develop, perform and promote interdepartmental integration and collaboration to enhance clinical services.
• Collaborate with and keep the VP of Healthcare Services informed of operational issues, staffing, resources, system and program needs and presents solution action plan for issues.
• Facilitate and participate in committees, task forces, work groups and multidisciplinary teams as needed to promote standardized Molina enterprise wide approach to Care Management programs.
• Ensure monthly auditing is occurring with appropriate follow-up.
• Engage in clinical training activities and outcomes.
• Develop and mentor HCS managers and supervisors.
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).
• 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.
Master's Degree in Business, Healthcare, Social Work or related field.
• 10+ years managed care experience.
• Operational and process improvement experience.
Preferred License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Utilization 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.
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