Molina Healthcare Dir, Healthcare Services - LTSS in Houston, Texas
The Director, Healthcare Services will be overseeing the LTSS teams in the Houston and El Paso regions, so the qualified candidate will be local to one of those areas.
KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):
• Directs and oversees one of the following key Healthcare Services functions: case management/disease management/care transitions; utilization management (Position oversees PA authorizations and manages the inpatient certification review staff for initial, concurrent or retrospective reviews); long-term supports and services; or nurse advice line.
• 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 and outcomes.
• Develops and mentors HCS managers and supervisors.
• This a full-time position.
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.
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.
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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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