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Dir, Healthcare Services- UM (Based in New Mexico)

Molina Healthcare Albuquerque, New Mexico Job ID 2023545
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JOB DESCRIPTION

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.

**This position requires managed healthcare experience with line management responsibility including Utilization Management.

KNOWLEDGE/SKILLS/ABILITIES

  • 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,based in New Mexico

JOB QUALIFICATIONS

Required Education

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).

Required Experience

  • 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.

Preferred Education

Master's Degree in Business, Healthcare, Social Work, or related field.

Preferred Experience

  • 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

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.

#PJHS

#LI-JR1

Pay Range: $79,607.91 - $172,483.8 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 03/01/2024

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  • Clinical, Albuquerque, New Mexico, United StatesRemove