JOB TITLE: Program Manager: HCS, Clinical Program Design, REGISTERED NURSEJob SummaryMolina 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
In collaboration with others, plans and executes internal Healthcare Services projects and programs involving department or cross-functional teams of subject matter experts, delivering products from the design process to completion.
Manages programs providing ongoing communication of goals, evaluation, and support to ensure compliance with standardized protocols and processes.
May engage and oversee the work of external vendors.
Focuses on process improvement, organizational change management, program management and other processes relative to the business.
Serves as a subject matter expert and leads programs to meet critical needs.
Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
Works with operational leaders within the business to provide recommendations for process improvement opportunities.
Conducts quality audits to assess Molina Healthcare Services staff educational needs and service quality and implement quality initiatives within the department as appropriate.
Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
JOB QUALIFICATIONSRequired Education
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 EducationMaster'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.
Program Specific Preferred skills:
Experience with leading program design for special needs populations including, but not limited to Duals, LTSS and non-LTSS
Clinical model design for Medicaid, Medicare and Marketplace lines of business.
5+ years of clinical nursing experience.
3+ years creating presentations and ability to present to varying stakeholder audiences.
3+ years regulatory/contract requirements review and analysis experience including clinical or case management program design.
Advanced experience with Microsoft applications: PowerPoint, Excel, Word.
Strong communication skills.
Program design experience must include ability to lead design exploration, inform project plans, program charters, program descriptions, establishing KPI’s and outcome reporting.
Experience working within applicable state, federal, and third-party regulations
3+ years supervisory/management experience in a managed healthcare environment.
Medicaid/Medicare Population experience with increasing responsibility.
Experience with NCQA requirements specific to population health and case management program requirements, as well as HEDIS and STARs.
Preferred License, Certification, AssociationAny 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: $84,067 - $171,058 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
