Job Description
JOB DESCRIPTION
The ideal candidate is an experienced healthcare professional with at least 7 years of healthcare experience, including a strong background in Utilization Management. Candidates must hold an active Nursing Compact License and be available to work Mountain Standard Time (MST) hours. Experience with Long-Term Services and Supports (LTSS) programs, particularly in New Mexico, is highly preferred. NCQA certification is a strong advantage and will distinguish top candidates. The successful candidate will bring a combination of clinical expertise, care management knowledge, regulatory compliance awareness, and a commitment to delivering high-quality member outcomes.
Job Summary
Leads and manages a multidisciplinary team of healthcare services professionals supporting members with long-term services and supports (LTSS) needs - ensuring members reach desired outcomes through integrated delivery and coordination of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Oversees team responsible for delivering long-term services and supports (LTSS) member care.
• Represents as an LTSS subject matter expert for care manager and service coordination staff, and provides direction and guidance to long-term services and supports (LTSS) care coordination team, and ensuring timely delivery of appropriate/quality services delivery and compliance with regulatory timelines.
• Ensures compliance with the state-specific memorandum of understanding (MOU)/contract scope of work.
• Assists leadership with state-specific LTSS reporting requirements.
• Collaborates with leadership to operationalize LTSS activities and oversight.
• Participates in county advisory groups and liaises with consumer advocacy organizations, members, caregivers (as appropriate) and other community-based organizations (CBOs) to ensure LTSS program integrity and identify areas for development.
• Develops and facilitates training for LTSS and managed care staff, community-based agencies, delegated entities, and other partners as needed.
• Oversees staff use of the electronic case management documentation system - ensuring compliance with Molina processes, standard documentation styles, established regulations and Health Insurance Portability and Accountability Act (HIPAA).
• Works collaboratively with area agencies on aging (AAA) and state or county agencies to provide oversight to ensure member needs are being met.
• Oversees the assessment and integrated service plan development process and monitors adherence to regulatory timelines.
• Develops and maintains relevant processes, procedures and reference material quality resource groups (QRGs) necessary to guide the service/care coordination staff in providing timely assessments, service planning, care coordination and appropriate referrals.
• Promotes multidisciplinary collaboration, provider outreach, collaboration with county social workers or other assigned care managers, and engagement of family and caregivers to enhance the continuity of care for members.
• Oversees interdisciplinary care team (ICT) meetings.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 7 years of experience in health care, including at least 3 years experience in a health care delivery network supporting long-term services and supports (LTSS) and in-home supportive services (IHSS), or equivalent combination of relevant education and experience.
• At least 1 year of health care management/leadership experience.
• Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT, Doctor of Psychology (PhD or PsyD). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Knowledge and experience with disability and senior access issues.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships with individuals.
• Strong time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Ability to work cross functionally within a highly matrixed organization.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
• Experience working with in-home supportive services (IHSS), public authorities, and community-based organizations (CBOs).
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.
