COE CM Director, (RN required)
Molina Healthcare Arizona; Phoenix, Arizona; Vancouver, Washington; Idaho Falls, Idaho; Boise, Idaho; Buffalo, New York; Grand Rapids, Michigan; Mesa, Arizona; Cedar Rapids, Iowa; Rochester, New York; Layton, Utah; Madison, Wisconsin; San Antonio, Texas; Orlando, Florida; Macon, Georgia; Dallas, Texas; Racine, Wisconsin; Scottsdale, Arizona; Tampa, Florida; Meridian, Idaho; Atlanta, Georgia; Green Bay, Wisconsin; Tucson, Arizona; Iowa City, Iowa; Lexington-Fayette, Kentucky; Detroit, Michigan; Miami, Florida; Orem, Utah; Bowling Green, Kentucky; Ann Arbor, Michigan; Akron, Ohio; Dayton, Ohio; Caldwell, Idaho; Chandler, Arizona; Jacksonville, Florida; St. Petersburg, Florida; Augusta, Georgia; Nampa, Idaho; Salt Lake City, Utah; Lincoln, Nebraska; West Valley City, Utah; Columbus, Georgia; Owensboro, Kentucky; Warren, Michigan; Louisville, Kentucky; Fort Worth, Texas; Des Moines, Iowa; Bellevue, Nebraska; Syracuse, New York; Omaha, Nebraska; Roswell, New Mexico; Columbus, Ohio; Cleveland, Ohio; Florida; Kentucky; New Mexico; Georgia; Ohio; Michigan; Iowa; Nebraska; Washington; Wisconsin; Idaho; Utah; New York; Texas; New York, New York; Houston, Texas; Austin, Texas; Bellevue, Washington; Rio Rancho, New Mexico; Seattle, Washington; Tacoma, Washington; Kenosha, Wisconsin; Kearney, Nebraska; Cincinnati, Ohio; Provo, Utah; Las Cruces, New Mexico; Santa Fe, New Mexico; Albuquerque, New Mexico; Grand Island, Nebraska; Sioux City, Iowa; Savannah, Georgia; Covington, Kentucky; Milwaukee, Wisconsin; Davenport, Iowa; Yonkers, New York; Spokane, Washington; Sterling Heights, Michigan Job ID 2029135This position requires an actively licensed Registered Nurse
JOB DESCRIPTION
Job Summary
The mission of Clinical Operations is to drive value through an integrated Clinical Center of Excellence and to deliver value through highly efficient shared service.
To achieve this objective, this role will support a specific Clinical Center of Excellence in establishing best practices and driving standardization and results across Molina Health Plans & Segments.
KNOWLEDGE/SKILLS/ABILITIES
- Review existing case management standards and processes and establishes new standards and processes to drive clinical excellence and quality results across the enterprise.
- Identifies case management best practices and capabilities across all plans and Lines of Business while supporting standardization.
- Responsible for monitoring CM KPI’s at plan and Enterprise levels. Engages with Clinical Analytics, Market Engagement team and Clinical Programs leadership to identify drivers of performance and address performance issues. Engages directly with Clinical program team to drive case management transformation and Integrated case management model concept design.
- Collaborate with other COE leaders across the enterprise UM, LTSS, BH, Quality, Office of the CMO, Network, Government Contracts, Growth and Community Engagement, Delegation
- Collaborate and facilitate activities with other shared services departments and with Molina Health Plans.
- Responsible for governance across all operational and strategic projects; escalates gaps and barriers in implementation, compliance, and/or program performance to AVP, VP and senior management.
- May supervise one or more Program Managers.
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
Bachelor's Degree in Nursing or a master’s degree in Business, Social Work or other healthcare 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.
Pay Range: $88,453 - $206,981 / 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: 12/11/2024ABOUT OUR LOCATION
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