Job Summary

Molina Healthcare Services (HCS) Department 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 members 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. The Pod Lead, HCS (Clinical) functions as clinical staff lead in the health plan HCS Department.  Responsibilities include oversight capabilities of daily administrative functions including staffing schedules, productivity, and work quality.

Job Duties

• Maintains the philosophy of the Pod concept, through intentional engagement of both internal and external Care Pod Partners with clinical, geographical, and technological expertise who collectively develop strategies tailored to individual members and their needs.
• Devises/implements a strategy for distribution of work to the care pod team based on identified member needs, risk indicators & member preference.
• Monitors the Care Pod workload and resource capacity, ensuring ability to maintain high quality member engagement and flexibility to support the unique needs of each member managed by the Pod.
• Hosts routine (daily/ad-hoc) check-in with members of the Care Pod to strategize and prioritize around workload, capacity, interventions, and activities.
• Accountable for coordinating care pod team interventions and activities, as well as maintaining the integrity of all internal and external communications related to member needs.
• Monitors operational dashboards and leading indicators; assessing Care Pod intervention & activity effectiveness and timeliness and adjusting CM strategies as needed.
• Promotes multidisciplinary collaboration, provider outreach, and engagement of family and caregivers to enhance the continuity of care for Pod-managed members.  Leads Interdisciplinary Care Team meetings
• Keeps Clinical Leadership apprised of operational issues, staffing issues, system, and program needs.  Provides inputs and ideas to leadership about how to improve workflows, processes, and procedures to optimize the pod performance
• Evaluates the performance of the Pod, and Pod team members.  Consults with Clinical Management to devise and implement corrective action as necessary to improve Pod and Pod team member performance.
• Maintains a minimum caseload as determined by leadership, for regular outreach and management
• Provides support, recommendations, and education as appropriate to Pod Team members.
• Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved quality and compliance. 
• Maintains confidentiality, cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Attends/participates in departmental, company-wide, and external committees, task forces, or work groups, as assigned.  
• As an opportunity to encourage staff, share monthly quality and productivity scores with individual staff for awareness.       

Job Qualifications

REQUIRED EDUCATION:

Graduate from an Accredited School of Nursing.  Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license OR bachelor’s or master’s degree in a health or social science, psychology, gerontology, public health, or social work

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3+ years in case management, disease management, managed care or medical or behavioral health settings.
• Knowledge and experience with working with persons with complex medical, behavioral, comorbid or co-occurring conditions and medication regimens
• Excellent communication skills, both verbal and written.
• Strong leadership qualities and ability to lead and achieve results
• Minimum of 3+ years data entry skills and minimum 3+ years’ experience utilizing a clinical platform.  
• Knowledge and experience with coordination specific to integrated medical & behavioral “whole person” care principles
• Understanding and experience with Key Performance Indicators and operational metrics
• Min 3+ years’ experience with Microsoft applications: PowerPoint, Excel, Word

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

• Certified Case Manager (CCM) certification within 24 months of hire
• Active, unrestricted State Registered Nursing (RN) license OR Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) OR licensure for Master’s level behavioral health therapist, to include any of the following:
  • Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), LMFT
• License must be active, unrestricted and in good standing.
• Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation

PREFERRED EDUCATION:

Bachelor’s or master’s degree in nursing, health or social science, psychology, gerontology, public health, or social work

PREFERRED EXPERIENCE:

5+ years of Case Management Experience.

2 + years working in Managed Care arena

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• Certified Case Manager (CCM)
• Master’s level behavioral health therapist, to include any of the following:
  • Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), LMFT

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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: $29.05 - $56.64 / HOURLY
*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.