COE CM Director, (RN required)

Job Description

This 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.

Job Info

Job Identification: 2029135

Job Category: Clinical

Posting Date: 2024-12-11T16:44:51 00:00

Job Schedule: Full time