Candidates must possess a current RN license, as well as a Bachelor's DegreeJOB DESCRIPTIONJob SummaryThe 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 standards and processes and establish new standards and processes to drive clinical excellence and quality results across the enterprise.
Delivers a unified or fully Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work cohesively to manage the needs of members holistically
Supports case management transformation and Integrated case management model concept design through planning and facilitation of discovery sessions, evaluation of operational capability, capacity, functional readiness, and program implementation.
Drives Enterprise clinical model design promoting standardization, end-to-end system design inclusive of KPI and outcome measures for all lines of business.
Collaborate with other COE leaders across the enterprise UM, LTSS, BH, Quality, Office of the CMO, Network, Government Contracts, Growth and Community Engagement) as part of clinical model design.
Demonstrates strategic leadership by directing efforts to deliver evidence-based interventions or programs that are impactful and improve outcomes for vulnerable populations.
Collaborate and facilitate activities with other shared services departments and with Molina Health Plans.
Acts in a consultative role, to assist in program development and clinical strategy.
Partner with COE VP to ensure COE is operating effectively and ensuring clinical consistency across the organization.
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 QUALIFICATIONSRequired EducationBachelor'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, AssociationIf licensed, license must be active, unrestricted and in good standing.Preferred EducationBachelor'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.Pay Range: $88,453 - $206,981 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
