Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed. Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
Develop Identity & Access Management Strategy (that includes Role-based Access Control (RBAC), application integrations, provisioning/de-provisioning, governance, Segregation of Duties, and Reporting & Compliance) and coordinate execution and implementation efforts.
Directs and oversees one of the following key Healthcare Services functions: case management/disease management/care transitions; utilization management; long-term supports and services; or nurse advice line.
Engage in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. He/she may also function as and perform all duties reasonably expected and assigned to an RN.
Oversees the maintenance of all Provider Contract templates. Works with Legal and Corporate Network Management as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirement.
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.
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.
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 meeting.