Mgr, Healthcare Services
4 days ago
Miami
Candidates must live in one of the following regions: \n\n \n \n Broward\n \n \n Monroe\n \n \n Manatee, Hillsborough, Polk, Hardee, Highlands\n \n \n Hamilton, Suwannee, Lafayette, Dixie, Columbia, Glichrist, Levy, Alachua, Union, Baker, Bradford, Levy, Citrus, Hernando, Lake, Volusia\n \n \n Sarasota, DeSoto, Charlotte, Glades, Lee, Hendry, Collier\n \n \n Pasco, Pinellas\n \n \n DeSoto, Glades\n \n \n Santa Rosa, Okaloosa, Washington, Liberty, Leon, Taylor, Madison, Wakulla, Escambia, Calhoun, Jefferson, Walton\n \n \n Palm Beach, Martin, St Lucie, Indian River, Okeechobee\n \n \n Miami-Dade\n \n \n Seminole, Orange, Osceola, Brevard\n \n \n\n \n Job Summary \n Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care. \n \n Essential Job Duties \n \n • Responsible for leading and managing performance of one or more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment. \n • Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model. \n • Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff. \n • Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care. \n • Oversees interdisciplinary care team (ICT) meetings. \n • Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities. \n • Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators. \n • 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. \n • Ensures completion of staff quality audit reviews; evaluates services provided, 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. \n • Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement. \n • Local travel may be required (based upon state/contractual requirements). \n \n Required Qualifications \n -At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. \n • Microsoft Office suite/applicable software program(s) proficiency. \n \n Preferred Qualifications \n \n \n \n To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. \n Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V \n #PJHS \n #LI-AC1 Pay Range: $73,102 - $142,549 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.