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
• Provides direction to and assists Molina State Health Plans enterprise-wide with implementing, monitoring, and achieving the Long Term Services & Supports (LTSS) program functions and goals per contract responsibilities.
• Provides oversight of State Plan LTSS clinical management functions. Provides leadership on the structural and clinical integration of LTSS services with Medical, Behavioral Health, and Pharmacy services.
• Refines and modifies clinical and social programs to meet regulatory requirements in multiple states while maintaining the integrity of enterprise standardization.
• Provides direction to State Plan leadership to ensure implementation of programs meet financial, utilization and quality outcomes.
• Conducts or oversees ongoing monitoring and auditing of plan performance on quality and outcome measures to determine success in LTSS standardization.
• Process ownership of Information Technology solutions for LTSS enterprise-wide..
Job Qualifications
Required Education
Bachelor's Degree in Public Health, Public Policy, Health Administration, Gerontology, Social Work, or related field
and/or relevant experience in lieu of clinical experience required.
Required Experience
• Min. 5 years health care management experience, including State Medicaid LTC (both institutional and home and community based).
• Experience creating interpretive guidelines and program development.
• Proven ability to set and achieve aggressive program objectives and goals.
• Proven ability to implement an effective monitoring program to include providing constructive criticism and requiring acceptable corrective action plans.
• Management of professional and non-professional staff.
• 3-5 years health care information systems experience.
Required License, Certification, Association
Active and unrestricted applicable State-Licensed Nurse, Licensed Independent Social Worker (LISW), or has Master's Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field.
Preferred Education
Master's Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field preferred.
Preferred Experience
N/A
Preferred License, Certification, Association
N/A
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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