Clinical Value Program Manager, HCS

Job Description

JOB DESCRIPTION

Job Summary

Working closely with Molina enterprise Clinical Operations and Health Plan healthcare services leaders, and Medical Economics and Finance teams, drive, plan and manage a comprehensive program focused on identifying, defining, designing, implementing and tracking performance for clinical programs that bring organizational value. Although primarily working with clinical teams, initiatives can overlap, and require collaboration, with Provider Network, Quality, Payment Integrity and other cross-functional areas. This individual contributor role is expected to take an active role leading this program and be accountable for its success, reporting to the Director of Clinical Value.

KNOWLEDGE/SKILLS/ABILITIES

• Lead teams in identifying, defining, sizing/validating, prioritizing, socializing, operationalizing and tracking clinical programs that result in financial value, as well as improve outcomes
• Develop, maintain and enhance processes, tools and reports to support this function
• Execute enterprise-wide communication plan to ensure consistent and regular messaging on plans and status
• Prepare agendas and materials for, and help facilitate recurring and ad hoc meetings
• Collaborate with and leverage supporting areas and processes - Enterprise Clinical Vendor, Clinical Centers of Excellence, Clinical Analytics, Clinical Systems, Medical Economics, Market Engagement, etc. to ensure efficient and effective program delivery
• Package material for senior leaders, up to and including for C Suite executives and the Molina CEO
• Extend scope to more fully include related areas besides 'Medical/Clinical', for example Behavioral Health, Long Term Care
• Assist in proposing and implementing an approach to ensure closer alignment between Clinical Operations and Provider Network processes for value programs that overlap end-to-end
• In some instances, serve as a subject matter expert and support program/process execution to achieve goals

JOB QUALIFICATIONS

Required Education

• 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 Nursing, Gerontology, Public Health, Social Work or related field.

Required Experience

• 5 years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management.
• Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.
• 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.
• 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

Master's Degree preferred.

Preferred Experience

• 3 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.

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.

Job Info

Job Identification: 2029063

Job Category: Clinical

Posting Date: 2024-12-13T13:38:31 00:00

Job Schedule: Full time