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Program Manager, HCS

Long Beach, California Job ID 1902429
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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.

• In collaboration with others, plans and executes internal Healthcare Services projects and programs involving department or cross-functional teams of subject matter experts, delivering products from the design process to completion.
• Manages programs providing ongoing communication of 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 the business.
• Serves as a subject matter expert and leads programs to meet critical needs.
• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
• Works with operational leaders within the business to provide recommendations for process improvement opportunities.
• Conducts quality audits to assess Molina Healthcare Services staff educational needs and service quality and implement quality initiatives within the department as appropriate.
• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.


Job Qualifications

Required Education:
Bachelor's Degree or equivalent combination of education and experience.

Required Experience:
• 5+ years of managed healthcare experience.

• 3+ years of Project or Program management experience.

• 3+ years of Process Improvement experience.
3+ years in one or more of the following areas: Utilization Management, Case Management, Care Transition and/or Disease Management. 

• Experience managing programs that include Healthcare Services policies and procedures for Utilization Management and or Case Management.
• Experience implementing training materials and new business implementations for Healthcare Services.

• Experience writing policies, procedures and RFP.

• 2+ years of healthcare supervisory or managerial experience, including oversight of clinical staff.

• Experience working within applicable state, federal, and third party regulations (CMS/NCQA).

Preferred Education:
Master's Degree.

Preferred Experience:
• 5+ years supervisory/management experience in a managed healthcare environment. 
• Medicaid/Medicare Population experience with increasing responsibility.
• 3+ years of clinical nursing experience.

Preferred License, Certification, Association:
Any of the following:
• Certified Case Manager (CCM), Certified Professional in Healthcare Management Certification (CPHM),  Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.
• Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Prtical Nurse (LPN) with experience in lieu of RN license.

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.


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