Remote Manager of Healthcare Services (Brain Injury)
Company: Molina Healthcare
Location: Des Moines
Posted on: November 25, 2022
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.
KNOWLEDGE/SKILLS/ABILITIES The Manager, Healthcare Services
provides operational management and oversight of integrated
Healthcare Services (HCS) teams responsible for providing Molina
Healthcare members with the right care at the right place at the
right time and assisting them to achieve optimal clinical,
financial, and quality of life outcomes.
- Responsible for clinical teams (including operational teams,
where integrated) performing one or more of the following
activities: care review/utilization management (prior
authorizations, inpatient/outpatient medical necessity, etc.), case
management, transition of care, health management and/or member
- Typically, through one or more direct report supervisors,
facilitates integrated, proactive HCS management, ensuring
compliance with state and federal regulatory and accrediting
standards and implementation of the Molina Clinical Model.
- Manages and evaluates team member performance; provides
coaching, counseling, employee development, and recognition;
ensures ongoing, appropriate staff training; and has responsibility
for the selection, orientation and mentoring of new staff.
- Performs and promotes interdepartmental/ multidisciplinary
integration and collaboration to enhance the continuity of care
including Behavioral Health and Long-Term Services & Supports for
Molina members. Oversees Interdisciplinary Care Team meetings.
- Functions as hands-on manager responsible for supervision and
coordination of daily integrated healthcare service
- Ensures adequate staffing and service levels and maintains
customer satisfaction by implementing and monitoring staff
productivity and other performance indicators.
- Collates and reports on Care Access and Monitoring statistics
including plan utilization, staff productivity, cost effective
utilization of services, management of targeted member population,
and triage activities.
- Ensures completion of staff quality audit reviews. Evaluates
services provided and outcomes achieved and recommends
enhancements/improvements for programs and staff development to
ensure consistent cost effectiveness and compliance with all state
and federal regulations and guidelines.
- Maintains professional relationships with provider community,
internal and external customers, and state agencies as appropriate,
while identifying opportunities for improvement. JOB QUALIFICATIONS
- 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
- 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,
- If licensed, license must be active, unrestricted and in good
- 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.
- 3+ years supervisory/management experience in a managed
- Medicaid/Medicare Population experience with increasing
- 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. Pay Range: -$73,101.84 - $142,548.59 a year* *Actual
compensation may vary from posting based on geographic location,
work experience, education and/or skill level.
Keywords: Molina Healthcare, Des Moines , Remote Manager of Healthcare Services (Brain Injury), Executive , Des Moines, Iowa
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