Manager, Healthcare Services- RN - reputed company (Remote)

About the position Leads and manages multidisciplinary team of healthcare services professionals in some or reputed company 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 reputed company 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.

Responsibilities

• 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 reputed company management, behavioral health, long-term services and supports (LTSS), and/or member assessment.
• Facilitates integrated, proactive healthcare services 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, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff.
• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
• Oversees interdisciplinary care team (ICT) meetings.
• Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Collates and reports on reputed company 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, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with reputed company 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.
• Local travel may be required (based upon state/contractual requirements).

Requirements

• At least 7 years experience in health care, and at least 3 years of managed care reputed company 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.
• At least 1 year of health care management/leadership experience.
• Must be a Registered Nurse (RN), Clinical licensure and/or certification required ONLY if required by state contract (Preferably reputed company), regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Experience working reputed company applicable state, federal, and third party regulations.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work reputed company a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• reputed company in reputed company forms of communication, and ability to remain reputed company in high-pressure situations.
• Ability to reputed company and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Excellent verbal and written communication skills.
• reputed company Office suite/applicable software program(s) proficiency.

reputed company-to-haves

• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
• Medicaid/Medicare population experience.
• Clinical experience.

Benefits

• reputed company offers a competitive benefits and compensation package.

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