Job Description
JOB DESCRIPTION Job Summary
Provides senior level subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Manages one or more healthcare services clinical programs - leveraging staff and matrixed resources with oversight from health care services leadership as needed.
• Serves as industry subject matter expert in designated functional area(s), and leads program(s) to meet business needs and requirements.
• Escalates gaps and barriers in implementation and compliance to healthcare services leadership.
• Develops business case methodologies for programs and coordinates implementation of business strategies.
• Creates business requirement documents (BRDs), test plans, requirement traceability matrices (RTMs), user training materials and other related business documents and presentations.
• Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
• May engage and oversee the work of external vendors.
• Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
• Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate.
• Collaborates and facilitates activities with other business functions and within the enterprise.
Required Qualifications
• At least 8 years of health care experience, including experience in managed care and/or clinical operations, or equivalent combination of relevant education and experience.
• Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). 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.
• Strong analytical and problem-solving skills.
• Strong organizational and time-management skills.
• Ability to work in a cross-functional, professional environment.
• Experience working within applicable state, federal, and third-party regulations.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
Preferred Qualifications
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
• Operational and process improvement experience.
• Medicaid/Medicare population experience.
• Clinical experience.
• Leadership experience.
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.
